It’s a waste free period for Flora

Monday March 18 2019



Flora Njelekela, founder of Hedhi Cup

Flora Njelekela, founder of Hedhi Cup 

By Jamila Khaji

Before 2015, 31-year-old Flora Njelekela had no idea what a menstrual cup was.

Menstrual cup, made of medial silicone, is a bell-shaped cup that collects menstrual blood. This flexible cup snugly fit into a woman’s vagina, catches the blood while she is on her periods. Once full, the cup can be emptied into a sink or toilet, washed and reinserted.

Just like many Tanzanian women today, when Flora heard about it for the first time, she too thought it was a strange concept. But an incident back at her grandmother’s village in Songea changed everything for Flora.

The idea of ditching the sanitary pads to an eco-friendly menstrual cup and also introducing it in Tanzania was borne out of what Flora says, “An eye-opener”. Flora hadn’t seen her grandmother for quite a while and decided to pay her a visit in the southern highlands.

One fine day, she took notice of an old, rag cloth that was hung on the rope. She asked her grandmother as to what these scraps of cloth were. “This is your cousin’s menstrual cloth which she uses when on her periods,” the grandmother responded. Flora was taken aback. The cloth did not seem hygienic at all, because her cousin would wash, dry on a rope and would re-use it again without ironing.

Flora’s cousin isn’t the only one. For many Tanzanian women and girls today, sanitary pad is a luxury and that is why most resort to unhygienic practices such as rag cloths, while some use soil and ash to soak up period blood. “I decided to give her my packet of sanitary pads.

But then I thought, what will happen to my cousin after I leave. Next month she will resort to the same dirty cloth because my grandmother cannot afford to buy her sanitary pads every month,” Flora tells in an interview with Your Health.

Flora came back to Dar es Salaam with a burden of thoughts of how to change her cousin’s life, and many other girls alike in the village.

She began her research on a sustainable, safe solution. She wasn’t far off with her research when one day she stumbled upon her colleague who was using a menstrual cup. “I found it strange but at the same time I wanted to know more about it, how it works, its durability and how hygienic it is.

So I started researching on it,” Flora adds. I was my own guinea pig Flora discovered that the menstrual cup can be used for more than five years. “I was my own guinea pig. I began wearing it in 2017 to see how comfortable, safe and hygienic it is. It’s something I cherish now,” Flora shares her own personal experience.

She adds that she can do anything with it without worrying about any leakages, discomfort or bad smell. “But upon my research, I found out that the menstrual cups were available in many countries but were not available in Tanzania,” Flora tells.

That’s when she decided to introduce menstrual cup under her brand name Hedhi Cup, that is sold for Sh30,000, making her the first Tanzanian woman to introduce this eco-friendly alternative. “I sort of finally felt safe for my cousin.

The soft, flexible cup made out of 100 per cent silicon, collects fluid three times more than normal pads making it a better substitution for unhygienic methods such as rags,” Flora tells. That means, for a normal period flow menstrual cups can stay in for up to 12 hours before being emptied and rinsed.

How safe is it? Dr Anna Mahecha, a gynaecologist based at Sanitas hospital in Dar es Salaam tells Your Health that a menstrual cup can be used by every woman; the difference is only the size. This can be measured by age and the amount of period flow.

She adds that she personally hasn’t used one because she wasn’t aware of its availability in Tanzania. “The menstrual cup is environmentally friendly. One cup can be used for more than five years without disposing it.

While with the normal sanitary pads, there is a lot of disposal and waste, some of them do not dissolve,” says Dr Mahecha. Besides its economic and environment factor, the cup is less prone to allergies or infection. “The material, silicone, that is used to make the cup make is safe as long as they are properly cleaned and preserved. You see with the cup, they collect instead of absorbing the fluid, making the user clean and dry,” she tells.

Upon asking about safety for girls who aren’t sexually active, Dr Mahecha says, “It is safe for virgins to use them.

They may feel a little uncomfortable at first but if inserted properly, it has nothing to do with virginity as it is not as deeply inserted as a tampon would. In fact they are better to use if one has a big period flow and prone to leakages.” The only impediment when it comes to wearing a cup requires proper knowledge on how to use, clean and preserve.

Are Tanzanian women willing to switch to a cup? Majority of women that Your Health interviewed were skeptical to try or switch to a menstrual cup.

Their responses varied from, “it looks uncomfortable”, “it might be a good thing to save the environment, but personally I won’t use”, to some saying “it is expensive.” The brief survey showed that like periods, there are several myths and apprehensions associated with menstrual cups. But out of those interviewed, Iman Hatibu, a communications officer with a policy forum in Tanzania, was the only one from the lot who touted the cup to be the most sustainable method of managing her menstruation. “I started using menstrual cup in 2015 before it was introduced in Tanzania.

I had ordered it from Finland. It had turned out very expensive. The cup is very comfortable and I can literally do anything with it – eat, sleep, swim, and more without feeling any sort of discomfort or leakage,” Iman, the mother of one, tells Your Health. Iman is very sensitive when it comes to allergies or infection.

“I have never experienced any sort of infection, in fact I don’t remember the last time I had a urinary or fungal infection,” she says. Adding on the skepticism from women, Flora says, “I can totally understand why women would have a negative approach towards this alternative. I was in their shoes.

That is why as a Hedhi Cup founder, I am emphasising first on educating women on its use and why it is a better, safe choice for women.” At an event held last week, Tanzanite Women Forum, Flora was one of the key speakers on menstrual hygiene and empowerment. She said at the forum itself, the kind of questions that were shot at her by women of different age and ethnicity had a skeptical tone.

But after educating the women about the cup, more than 40 women changed their minds and decided to try the menstrual cup.

The question of affordability For middle-income earners, the menstrual cup might seem an economical choice but for those who come from a less-fortunate background, the cup is still a luxury item.

In order to reach out to the masses, Flora says, “Yes it still seems a lot of money for those who come from a poorer background.

We have been sending proposals to corporates, NGOs and companies to buy these so that we can go the villages and educate them on its use. This is just a start, more needs to be done.”

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How you can escape chains of depression

Monday March 11 2019

 

By Syriacus Buguzi @buguzi sbuguzi@tz.nationmedia.com

Dar es Salaam. Over a year ago, Doreen Peter Noni, 30, realised that her life wasn’t making sense anymore after her father, was put in remand prison. A feeling of hopelessness was creeping into her life and the rest of her family members, she says.

“I could cry a lot with my sister in law and I would express my feelings about it[…]I would lock myself into the room and cry…and cry…and cry…I was struggling to be positive about it but I also realized that other family members were also struggling to be positive…,” says Doreen.

Doreen, the daughter of Mr Peter Noni, former Managing Director with what used to be known as Tanzania Investment Bank (TIB), felt restlessness when her father was charged with counts that would see him spending several years behind bars.

“At home, we had been a loving family, close, supportive and energetic but it’s like we lost the energy. We were all struggling in our own ways but no one was speaking out. I had to take charge,’’ recalls Doreen as she narrated her past tribulations to Your Health.

“My family saw the energy in me, especially after they realized how I was going to see my father in [remand] prison and coming back. But at times my family would get irritable over a small matter, I realized that the pattern of our relationship had changed,’’ she further recalls.

“I lived like that for several months. I tried to find comfort in friends—my long time friends but you know, it wasn’t easy. I could experience some sort of stigma…I could get disappointments from people I had thought would be there for me but they weren’t.”

“That was happening while I was in Dar es Salaam. But I had my business in Mwanza so I had to run the business remotely. That was even more challenging for me. My father owned businesses and we had to make sure it keeps running but that wasn’t easy.”

“So, problems just kept adding and adding and adding...”

Light and end of the tunnel

“There was a time I travelled to Portugal for a global meeting…where I had been invited to be a speaker…I started a panel discussion with a man known as Mark Mahajjar who had been imprisoned with Nelson Mandela. He was explaining how Nelson Mandela changed his life and the experiences they went through of not being able to provide for their families while in prison..

He said a lot of things that I felt I could relate with and for the first time I felt like I was not a lone, and found myself raising my hand and standing up to speak…after this [occasion] I had a lot of men and women coming around to speak to me and I realized there were untold stories of people with hidden suffering…”

“That whole experience and people opening up and speaking their problems, made them feel good. They were speaking about depression. I had never used that word and in fact I hated saying that I am stressed.”

“I started reading about depression when I was in the US [United States] and I realized that I was going through depression because I read the symptoms and I said Oh My God! That’s what I have been going through. I also realized that’s exactly what my family members had been going through too.”

“By the time I came back home,[in Tanzania] I already had a different mindset, I had strength to be able to speak out about my problems without feeling that I would be laughed at or stigmatized because I knew I was not alone. There were those who had gone through a tougher environment.”

“Later, I joined peer groups…I met a friend who told me she had attempted to commit suicide two times because of what she had been going through. I was so shocked. I had never thought about it.”

‘Peter’s Daughter’ is born

“This whole experience gave me an idea to start Peter’s Daughter Project. This was born because Peter was a great man and who raised me with good values. I tried to do good to people that [my father] doesn’t k now.”

“That was how I decided to start searching into the dangers of depression and came up with an idea to help others who could be going through a similar situation,” she said.

Being an entrepreneur, who runs Lake FM Radio in Mwanza, Doreen thought of doing something that would deliver the message of how to get rid of depression to other people.

“That was how I came up with an idea to prepare a series of programmes – to be aired on TV, Radio and online platforms – profiling people who have been going through depression,” she says.

The idea, codenamed “Peter’s Daughter Project” emerged as the first winner at this year’s Total Starterupper of the Year Awards, bagging Sh30 million from Total Tanzania.

It was an idea that was borne out of pure bad luck for Doreen but one that made her start seeing life differently. She now believes that talking and opening up is a cure to many psychological problems, including depression.

What she now tackles is something of worldwide concern. About two years ago, the World Health Organization (WHO) sensitized people around the world to embrace the power of talking as a way of dealing with depression, as countries marked World Health Day, themed: Depression: let’s talk.

According to a clinical psychologist based at Muhimbili National Hospital (MNH), Mr Isaac Lema, about 5 in 10 patients visiting the mental health department where he works, exhibit signs and symptoms of depression at various stages.

“In fact, encouraging the patients to talk or speak up their inner psychological challenges helps relieve them of a burden. We employ this strategy in various interventions for our mental health patients here,’’ says Mr Lema.

Experts say people who harbor problems in their psyche, may develop feelings of self-doubt and later this may swiftly turns into depression and one of the surest ways to get out of the trap is “…talk, talk your problems….

Mr Lema says, however, depression is in various stages. There are those with signs and symptoms of depression which are not severe. “But there are those who indeed exhibit very serious depression, we call clinical depression. This requires more serious interventions,’’ he says.

For most people who are not aware about depression, there is a tendency to believe that they have been cursed or have demons. This condition can happen to anyone regardless of age.

At the WHO level, experts believe one of the first steps is also to address issues around prejudice and discrimination. During the World Health Day in 2017, WHO sent messages around the world on depression.

“The continuing stigma associated with mental illness was the reason why we decided to name our campaign Depression: let’s talk,” said Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at the WHO.

Depression is a risk factor for suicide, which claims hundreds of thousands of lives each year, said Dr Saxena.

“A better understanding of depression and how it can be treated, while essential, is just the beginning. What needs to follow is sustained scale-up of mental health services accessible to everyone, even the most remote populations in the world.”

Researchers believe that getting people out of the chains of poverty and financial challenges can significantly get rid of many mental health challenges—including depression.

A survey titled: Common Mental Disorders and Risk Factors in Urban Tanzania, also shows that the CMDs are highly associated with exposure to traumatic life events in urban Dar es Salaam, particularly events involving relationship difficulties and financial instability.

“Efforts to address poverty and disadvantage in low income countries such as Tanzania will need to take mental health into account and address the difficult circumstances and environments within which people live and work,’’ suggests the survey published in the International Journal of Environmental Research and Public Health.

For the case of depression, it creates feelings of severe despondency and dejection and according to data released by the WHO ahead of the World Health Day marked yesterday; more than 300 million people are now living with depression globally.

For many years in Tanzania, mental health experts have been raising the profile of depression and the impact it has on society, encouraging the society to speak up—data released on Tanzania speaks volumes.

A facility-based analysis by Dr Sylivia Kaaya from the Department of Psychiatry and Mental Health at Muhimbili University of Health and Allied Sciences(Muhas), shows that the data collected from 20 Regions in Tanzania from 2006-2007, showed that depression accounted for 7.5 percent of all reported (89,045) patients with mental disorders.

On a global scale, the number of people living with depression by 2015 had reached 322 million, up 18.4 percent since 2005, the WHO says in its database.

Failure to act now is costly, according to a study by the WHO; which calculated the treatment costs and health outcomes in 36 low-, middle- and high-income countries for the 15 years from 2016-2030.

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How harmful is sitting for long?

Monday March 11 2019

 

By BEATRICE NAKIBUUKA

We are bound to lead a sedentary lifestyle because of the kind of work we do. You could be spending 40 hours per week in a sitting position without exercising and this is likely to affect your health.

Besides gaining unnecessary weight, you are also more likely to die earlier from different lifestyle diseases such as diabetes.

According to Dr Nobert Bwana, a physiotherapist at Physique Centre in Kamwokya, sitting for long hours affects several parts of the body.

He says, “If you sit for too long, your brain could look just like that of someone with dementia. Sitting also raises your risk of heart disease, diabetes, stroke, high blood pressure, and high cholesterol, which all play a role in the condition. Moving throughout the day can lower your risk of all these health problems.”

Clotting in the legs

Sitting for too long can make blood pool in your legs which adds pressure in your veins. They can swell, twist, or bulge causing varicose veins.

One may also develop a clot that forms in your leg. The clot maybe painful and swollen but there may not be any symptoms for some people. It can be fatal if the clot breaks free and lodges in your lung. That is why it is a good idea to take breaks between long sitting sessions.

Wrecks your back

Dr Bwana says, “Sitting in one position puts alot stress on your back muscles, neck, and spine. Slouching is even worse. Find a chair of the right height and give support to your back in the proper spots. Even with a comfortable chair, try to move around for a minute or two every half hour to keep your spine in line.”

Failure to lose weight

If you have tried to lose weight but are not shading off any kilos, it could be because you are sitting for a long time.

Older adults who are not active may be more likely to get osteoporosis (weakened bones) and could slowly become unable to perform basic tasks such as taking a bath or using the toilet.

While moderate exercise will not prevent it, too much of it may ruin your bones.

It is important, therefore, to get a personal instructor to help you identify the type of exercises that would be helpful to you.

Increased cancer risk

“The longer you sit, the higher the odds of you getting colon, endometrial, or lung cancer, says Bwana. Sitting for longer hours also exposes older women to the risk of breast cancer. It is recommended that while you work, stand up and stretch every half hour or so. Touch your toes; take a stroll around the office. Stand at your desk for part of the day.” There are simple but helpful exercises that you can do without leaving your workstation.

Sit properly

Even before you exercise, make sure you sit the right way. Your chair should be at the proper height to reduce strain on your neck and back, according to Dr Quraish Golooba, a physiotherapist at Case Hospital.

“Keep the lower part of the spine flat against the back of the chair to maintain proper curvature. The chair will help keep the rest of your back and neck erect in order to decrease your chance of bending forward, which can cause spasms in the back and neck and lead to headaches,” he says. The impact of movement can be profound. For starters, you will burn more calories. This might lead to weight loss and increased energy.

Also, physical activity helps maintain muscle tone, your ability to move and your mental well-being, especially as you age.

Easy exercises to try

Shoulder stretches: Raise your shoulders upwards in a shrugging position and hold them there for a few seconds. Release them and repeat several times. Arm stretch: You can also stretch the muscles in your right arm by reaching as far to the left as you can with your right arm while supporting it with the left elbow and then hold it there. Feel the stretch for about five seconds then repeat with another arm.

Elbow to knee twists: “Sit up straight in your chair and put your hands on the sides of your head. Twist your body to the right, lifting your right leg and bringing your left elbow towards your knee.

Hold this position for a second, and go back to sitting upright. Now do the same thing with the right elbow and left knee. Do this over and over again,” says Dr Quraish Golooba, a physiotherapist at Case Hospital.

Hip relaxing: “Another perfect exercise that keeps your hands completely free is to sit straight in your chair, and keep your knees at a 90 degree angle. Now raise one foot off the floor and hold it in that position as long as you comfortably can put your foot down and raise the other foot in the same way. Repeat several times to relax your hip muscles,” he recommends.

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Birth control: Why not men?

Monday March 11 2019

 

By Pauline Kairu

In 2016, men participating in what sounded like a promising trial (a sperm destroying two-hormone injection), dropped out complaining of ‘too many side effects’.

Initial results showed that the contraceptive would be 96 per cent effective in preventing pregnancy. But the Stage II trial was stopped after the side effects complaints.

According to results published in The Journal of Clinical Endocrinology and Metabolism, the most common side effect men complained about was acne. But then there were others like: mood swings, weight gain, low libido.

This caused moments of exasperation on the Internet, because these don’t fall outside of the range of side effects considered in the female contraception world as incidental ordinary risks.

The men in the trial were accused of being too wimpy to handle the discomfort women on the pill face every day.

Side effects

Despite these side effects, which stopped after the men went off the pill and their hormone levels returned to normal, many study participants said they’d take the pill in real life if it were available.

One of the researchers behind the trial, Arthi Thirumalai from the University of Washington, expressed frustration because the male pill was found to be more convenient than some current birth control options for women.

“We did see mild weight gain and slight changes in the good cholesterol which requires us to fine tune the dosing and maybe look a little more closely at the formulation, but overall we’re very encouraged about the safety profile of the dimethandrolone undecanoate (DMAU),” said Dr Stephanie Page, one of the co-authors of the research in a press release by the endocrine society website.

Another fear amongst most men has been that the compounds might cause permanent alterations to sperm production.

There have also been concerns over the effects of hormonal birth control on the liver. The same ones that women on the same compounds would be exposed to.

For instance, the pill which has been the longest form of male contraception on trial, has proven so difficult because the hormones are quickly metabolised by the liver.

But according to Thirumalai, “It is quite old-fashioned to think that men would forget to take the pill; survey data shows that men want to take responsibility for contraception too.

Dr Page, notes that globally, 60 to 80 per cent of men surveyed suggest they would be interested in a reversible male contraceptive if it were available.

More than 30 per cent of those responding to a multinational survey said they prefer to use a daily oral pill as opposed to an injection or an implant.

Long-standing question

About the long-standing question of men’s willingness to use a contraception, and women’s readiness to trust them to use it, Dr John Kinuthia, an obstetrician/gynaecologist at the Kenyatta National Hospital who is leading the male gel contraceptive trial in Kenya, says, “attitudes have changed.”

“We are often asked whether men will be compliant/ can be relied upon and whether women will trust their partners to use something since they bear the burden of pregnancy.

“International surveys that reveal men are very interested and willing but they simply don’t have great contraceptive options.

“More than 80 per cent of women in committed relationships in global surveys say they would trust their partners to use a male contraceptive,” said Dr Kinuthia.

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GUEST COLUMNIST: Traditional medicine beyond myths

Monday March 11 2019

 

By Eleonorah Erio

When I was a nursing student, I used to find patients with therapeutic marks on different parts of their bodies, and I recall my fellow students relating those marks to witchcraft. Most of the people in Tanzania associate traditional medicine with the supernatural, and consequently do not prefer traditional medicine as an alternative practice to relieve or cure some diseases.

This situation is quite different compared to other countries such as India or China where traditional medicines are highly regarded as esteemed medical remedies that are backed by scientific facts. In such places, traditional medicines are used for various medical purposes such as treatment of diseases and industrial medicine development.

Why is traditional medicine regarded as a supersition?

Dr Paul Mhame, Assistant Director, Traditional and Alternative Medicine Unit in the Ministry of Health, Community Development, Gender, Elderly and Children explains that the majority of Tanzanians neither know nor appreciate their history. Foreigners during colonial rule likened traditional healers, traditional practices and their setting with witchcraft related practices.

However, the use of traditional medicines goes as far back as the colonial era where traditional healers tried to disrupt white people who want to destruct their practices but it has nothing to do more than securing their practices. People regard traditional medicine practices as a myth due to the fact that many religious groups undermine traditional medicine. Many traditional health practitioners’ facilities and attire are believed to be superstitious.

Similarly, during the colonial era, traditional medicine was regarded as a threat to business and the modern medicine.

Currently, traditional medicine stands as a threat to modern medicine instead of complementing it. In order to advance traditional medicine, we as Tanzanians need to change such negative attitudes.

Government role in promoting traditional medicine

Traditional and alternative medicine is being integrated into the National Health Policy as it has a significant contribution to the provision of healthcare services in Tanzania. Currently, 60 per cent of the Tanzanian population seeks healthcare services from traditional health practitioners. Moreover, according to World Health Organisation (WHO), the traditional health practitioner’s coverage within the community is 1: 750 as per WHO standards, contrary to conventional health practitioners with only 1: 20,000

The Government through the Ministry of Health, Community Development, Gender, Elderly and Children has set regulations, guidelines, code of ethics and conduct to govern the traditional medicine practices.

Among the malpractices prohibited include killings, superstitious beliefs and practices. If a registered traditional health practitioner is found liable for malpractice, they will be held liable for a criminal offence as stated under the Traditional and Alternative Medicine Act 23 of 2002 and other legislation accordingly.

Opportunities in traditional medicine

The myth surrounding traditional health medicine hinders the community from exploring great opportunities in this field.

Traditional medicine provides ample opportunities for investors and businessmen to establish industries that consume raw materials from more than 12,000 medicinal plant species across the country, while simultaneously upholding the government’s industrialisation policy.

It is also a great opportunity for all 126 ethnic groups to utilise their ethnic knowledge and come up with medicines that may be used for many years to improve the quality of life or cure diseases.

The author is a registered nurse (RN) with Traditional and Alternative Health Practice Council in the Ministry of Health, Community Development, Gender, Elderly and Children.

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Study finds potential new weapon in fight against malaria

Monday March 11 2019

 

For years, insecticide-soaked mosquito nets have helped dramatically lower malaria infections, but insecticide resistance has driven a search for alternatives and a new study may have uncovered one option.

The weapon is a familiar one: an anti-malarial drug already used by humans to prevent them contracting the disease, and researchers now envisage using it on netting like insecticides.

Their research shows the drug works on mosquitos, killing the malaria parasite in the insects and preventing it from being transmitted.

It is a potentially important breakthrough in the battle against a disease that killed 435,000 people in 2017, the majority of them children under five in Africa.

In 2017, the number of malaria cases climbed to 219 million, a worrying rise from the previous year and a sign that long-standing progress is being reversed.

The researchers, including Flaminia Catteruccia, a professor of immunology and infectious diseases at Harvard University, found exposing mosquitos to even low doses of an anti-malarial called atovaquone or ATQ caused “full parasite arrest”.

“We tested a couple of anti-malarials, and it worked beautifully with ATQ: all parasites were killed!” Catteruccia told AFP by email.

The team was initially looking for ways to sterilise female mosquitos that had developed insecticide resistance, to prevent resistance spreading.

“We are quite excited that this new idea could really help in the fight against malaria in a manner that is safe for people that sleep under those nets and for the environment,” Catteruccia said.

But the researchers acknowledge that significant work is needed before anti-malarials can be used directly against mosquitos, and there are risks.

Mosquitos are unlikely to develop resistance to ATQ because it doesn’t affect their survival or reproduction, but when it comes to the malaria parasites “emergence of resistance is always a risk”, Catteruccia said.

The prospect of an ATQ-resistant strain of malaria is particularly problematic because the drug is a key plank in treating the disease in humans.

To tackle that problem, the researchers propose investigating other drugs that kill the malaria parasite in different ways.

“By using different drugs in humans and in mosquitos, we could reduce the chance of drug resistance emerging,” said Catteruccia.

The team will also need to look at the cost of using the drug, and how stable it would be over time when exposed to the elements on a net.

(AFP)

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Doc, why do my feet ache?

Monday March 11 2019

 

I feel pain in my ankles and the soles of my feet, on and off. A doctor recently told me it has something to do with the quality of shoes I wear, but I didn’t believe him. Could the pain be due to the long distances I used to walk in the past that might have affected my soft tissues and muscles, causing them wear and tear? Or might it be arthritis? ADW

Dear ADW,

You are most likely suffering from plantar fasciitis, which means inflammation of the fascia on the bottom of your foot. The plantar fascia is like a sheet of fibrous tissue that connects the heel to the front of the foot, where the toes start. It supports the foot, helping us walk by acting as a shock absorber. It can easily get injured or torn due to too much pressure on the feet. When this happens, there is pain, usually after starting to walk after sitting or lying down for long, or after being on your feet for long. It is more common in those who are overweight or obese, those whose jobs require them to stand or walk for long durations of time, and in long-distance runners.

It can also occur during late pregnancy, and in those with flat feet or a high foot arch. Wearing shoes with poor arch support also contributes to the problem.

To manage it, reduce the pressure on your feet by reducing walking and standing. You can stretch and massage your feet before getting out of bed in the morning and after being on your feet for long. Wear shoes with a cushioning sole e.g. thick rubber sole or sneakers. Get shoes with good arch support, or get heel cushions from the hospital, a pharmacy or even the supermarket. Painkillers also help to reduce the pain and inflammation. You can also see a physiotherapist to help with exercises for the feet and legs. In case you have tried all this, and you are still in a lot of pain, you may require a steroid injection to the damaged area, which should be done by an orthopaedic specialist.

My menses smell awful and doctors say it is because I have an infection. I have gotten injections and taken strong antibiotics for a year now, but the smell lingers. Please help me. CN

Dear CN,

Normally, there is a smell from the monthly period as the body sheds blood and the lining of the uterus. The smell is further compounded by the sanitary pads or tampons, some of which are perfumed. Sanitary pads and tampons interfere with airflow and may encourage bacterial growth and buildup of odours, and this is worse if one does not change regularly.

There may be change in the vaginal pH during menses leading to bacterial overgrowth, causing a bad smell. This pH change and overgrowth corrects itself when the periods are over. The pH can also be affected by medication, supplements, food, alcohol, caffeine and detergents.

You can also develop a bad smell due to vaginal infection, inflammation of the cervix, ovarian cyst, or even cervical or endometrial cancer (cancer of the uterus).

Prevent vaginal infections by maintaining hygiene, wiping from front to back, wearing cotton underwear, avoiding tight clothes, avoid douching and use of feminine hygiene products, avoid using harsh detergents, practise safe sex and have your partner(s) checked and treated any time you are found to have a vaginal infection. Also, when on your menses change sanitary pads or tampons at least every six hours.

You also need to get proper screening for infection by having a high vaginal swab (HVS) taken for analysis and culture, and screening for chlamydia infection and pelvic inflammatory disease. You should also have a Pap smear done regularly.

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Endless struggle of a single mom to save her son

Monday February 25 2019

 

By John Namkwahe @johnteck3 jnamkwahe@tz.nationmedia.com

Upendo Lukongo, 40, a mother of six children had never imagined that she will one day end up spending months at a heart facility until when her last born child was diagnosed with a heart condition that necessitated prolonged medication and surgery.

Ms Lukongo, a small-scale farmer from Mwakikonge village in Tanga Region narrates to Your Health about her struggles of seeking treatment for her three-year-old son, Richard.

“My other five children grew up healthy and had never developed any serious illness except my last born. At the age of three months, he started developing surprising symptoms; he was crying a lot all the time. I was confused,” says Ms Lukongo.

But when she took him to a nearby hospital, the doctors could not detect any serious condition or ailment. With persistent symptoms, it prompted the doctor to transfer them to the Muhimbili National Hospital (MNH) for specialised medical check-up.

At the MNH, the hospital results showed that the child had an enlarged heart, something he was born with, a symptom of an underlying problem that is causing the heart to work harder than normal, biologically known as cardiomegaly, and it necessitated prolonged medications. They were transferred to Jakaya Kikwete Cardiac Institute (JKCI) for specialised care. “We were admitted in the hospital for one month, and then we were discharged. The doctor instructed us to report to the hospital after every six months for clinic sessions,” Ms Lukongo narrates to Your Health.

The heart condition

“It can also be seen in children but is less common, as it normally occurs in adults. Many of the children that we receive here are diagnosed with other types of heart defects such as heart valve disease,” said the JKCI’s Paediatric Cardiologist, Dr Sulender Kuboja.

In some people, an enlarged heart causes no signs or symptoms. Others may experience shortness of breath, abnormal heart rhythm and swelling, according to the health experts.

According to Dr Kuboja, some cases of enlarged hearts in children are caused by valve problems.

“Valves that don’t open properly, or valves that leak can create extra stress on the heart, resulting in enlargement,” explained Dr Kuboja.

Start to a difficult journey

In December, 2018, when Ms Lukongo and her son were preparing to attend the clinic session as instructed, she fell sick, a situation that had forced them to skip the clinic session.

“I am a mother and a father of this family. My husband had died when our last born was only three months old. So when I fall sick, no one is taking care of my children, I therefore need to be strong even when I feel weak,” says Ms Lukongo.

On February 13 this year, Ms Lukongo took her son to JKCI for a clinic session.

The hospital results had shown that her child’s heart had grown bigger; the doctor advised them to come back the next day for a second screening.

“The doctor has told us to come back tomorrow. He also gave me a list of medicines to buy from the pharmacy, but unfortunately I don’t have money,” says Ms Lukongo.

Ms Lukongo is currently at JKCI waiting for her son to undergo a rare surgery. This follows, the doctor who examined the child had advised that Richard must undergo a surgery in order to treat the condition.

“I don’t know when exactly the doctors will perform the surgery, but we have been told to wait as they still continue to examine the condition,” says Ms Lukongo.

The JKCI’s Paediatric Cardiologist, Dr Naiz Majani was recently quoted by The Citizen saying children with correctable heart defects in Tanzania often fail to undergo surgeries because of lack of financial support.

Treatable but costly

The JKCI public relations officer, Anna Nkinda told Your Health over telephone that most of the children with heart defects who are visiting the institute, their treatment costs are covered by the facility.

“We normally contribute the treatment costs for the children and adults who are referred here for treatment coming from poor families after they are being assessed by our Social Department for financial support,” said Ms Nkinda.

She added, “For example, the treatment cost for children with heart valve disease is Sh15 million. But I am not sure about the treatment cost for children with enlarged heart condition.”

Free treatment?

The national health policy doesn’t stipulate that all heart disease patients visiting the JKCI should access free treatment. Under this course, majority of the patients have to dig in their pockets to cover the treatment costs.

When contacted over telephone, the deputy minister of Health, Community Development, Gender, Elderly and Children Dr Faustine Ndugulile elaborated that the government was currently providing free medical services to at least 60-70 per cent of Tanzanians categorised into different groups including cancer and heart patients.

“Treatment for heart diseases is very expensive and there isn’t any country that provides free medication for cardiovascular diseases. Therefore I can’t promise anything at the moment concerning free medical services for heart diseases,” said Dr Ngudulile when he spoke to Your Health.

The minister further reiterated that the government was determined to continue raising public awareness on importance to avoid engaging in lifestyle factors such as smoking and unhealthy eating that constitute diverse of health complications including cancer to the consumers.

“Through the Health National Policy, the government is committed to prevent and offer treatment for Non-Communicable Diseases like cancer and cardiovascular,” said Dr Ndugulile.

Treating heart defects extended

The government is intending to extend its expertise on cardiovascular treatment to other facilities throughout the country, in a bid to improving the cure of heart ailments.

Recently the government through health ministry launched a Cardiac Catheterisation Lab or “Cath Lab” for heart treatment at Dodoma based-Benjamin Mkapa Hospital in efforts to extend heart treatment across the country.

At JKCI, the management secured funds from the government to construct a new facility to accommodate children with heart defects visiting the institute.

“The aim is to reach out to as many heart patients as we can by availing similar services in other facilities in the country including Benjamin Mkapa and Bugando Hospitals,” said Prof Mohamed Janabi who was quoted recently.

Adding: “Previously, the institute could only conduct surgeries by 30 per cent, but with the support that we have been receiving, now 65 per cent of all heart surgeries are being done by our experts and the remaining 35 per cent with assistance of medical teams from abroad,”

Prof Janabi further asserted that the assistance has enabled the country to save up to Sh70 billion by performing rare heart surgeries on 2,440 patients in the past four years, both children and adults who were suffering from heart diseases, instead of transferring them abroad.

“Our goal is to reach as many patients as we can by the year 2020,” Prof Janabi was quoted.

As for Ms Lukongo, what’s left is hope to save her son Richard from a correctable birth defect while she awaits either for a financial aid or her turn to be one of beneficiaries of free treatment.

This is the reality many Tanzanian families face in treating unexpected ‘expensive’ diseases and illnesses.

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Stop foot fungal disease in its tracks

Monday February 18 2019

 

By Joan salmon

Bryce Kazungu came home with a new pair of shoes and he was excited. These were the work boots he had been looking for and they were comfortable.

However, two weeks down the road, he started experiencing itching around his small toe; on the skin and sole but brushed it off thinking he needed to give closed shoes a break for a while.

“At the end of the day after he resumed using closed shoes, the new pair in particular, the itching was unbearable,” Kazungu says.

On removing the shoes, his sole had blisters while the upper part had flaky looking skin. “I was alarmed that I rushed to the nearest clinic only to discover that I had a fungal infection,” Kazungu says adding: “I received an anti-fungal powder that I used religiously and dried my toes thoroughly after bathing.”

However, because he had to visit construction sites regularly, this new pair of shoes was his best option and as you would have it, the infection blossomed. Trying to see why there was no change, Kazungu stopped putting on the shoes for a week and resumed thereafter. The infection seemed to disappear during the break but came to life the very day he resumed wearing them.

“I confirmed that these shoes were the problem because whenever I took a break from them, I still used closed shoes,” Kazungu says. He shelved the shoes and the infection died out completely.

What is a fungal foot infection?

“It is medically known as tinea pedis caused by a fungus with the ability to live and feed on the protein keratin found on animal skin, hair and nails,” Dr Edward Ogwang of The Skin Specialist, explains.

“Fungal foot infections are more common in adolescents and adults although can affect people of all ages,” Dr Sabrina Kitaka, an adolescent specialist at Mulago University College of Health and Sciences, explains.

Although many of the risk factors for a fungal foot infection are preventable, you are more likely to develop a fungal foot infection if you have diabetes, have a disease that causes poor circulation, swim in a public swimming pool, share items such as towels, socks and shoes, have moist fingers or toes for an extended time, have a weakened immune system, wear closed-toe shoes such as tennis shoes and boots, smoke, have family members with it, walk barefoot on a communal floor or spend a lot of time in the water.

Prevention

Dr Kitaka says wearing shoes without socks causes the moisture from your sweat to remain around the foot for long. This increases the risk of infection forming. Therefore, get a pair of cotton or wool socks and avoid re-wearing socks.

Do not share socks, shoes, or towels with others and change your socks when your feet get sweaty.

Alternate between at least two pairs of shoes, wearing each pair every other day, to give your shoes time to dry out between use.

Wash your feet with soap and water daily and dry them thoroughly, especially between the toes. Wear sandals in public showers, around public swimming pools, and in other public places. Additionally, make sure your shoes fit well and are made of material that lets air move through it, like canvas or leather.

Get ample sleep because as much as a poor diet can contribute to a fungal infection, so can sleep deprivation.

Less sleep means less strength for your body’s immune system. If you cannot get six to seven hours of sleep each night, start the day by taking a comprehensive multivitamin to lessen cravings.

Become more active. Dr Kitaka says feet get fungal infections owing to their location. Your circulatory system struggles to work effectively and efficiently around your toes. Therefore, toxins that would normally be removed linger yet fungus feeds on them.

Being active increases the strength of your circulation system thus reducing infection risks.

“Stop the potential of spreading the infection; anything you apply to your foot that isn’t an anti-fungal item could spread the infections to other body parts. For this reason, avoid using things like nail polish until the infection resolves,” she advises.

Treating concurrent nail infection is also very important when dealing with fungal foot infections.

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The way forward to better healthcare

Monday February 18 2019

 

By Punit Solanki

I was talking to a colleague from university, who is now part of a management committee of a certain hospital. We conversed about a lot of things.

When he raised concerns about the quality of our healthcare system, I couldn’t help but be hysteric about it. Not because I can understand the vicious cycle that we are in but because I didn’t know where to start from with regards to it.

He continued saying, a hospital thrives of the quality of healthcare it provides, and if without that, we may not be able to sustain it forward for a very long time.

Mind you this is the same management committee that heads hospital’s decisions and due to a budget, it chooses a minimum number of healthcare professionals to work with.

With the demand of patients, we do not expect the health professionals to have quality time with each patient thus producing poor therapeutic outcomes.

It is not that the health professionals are incompetent, but it is because he/she wants to practise his/her best but what limits them is time and large number of patients.

This decline in quality healthcare then corresponds to less patients preferring the hospital and thus less capital in return, which cannot invest in better health professionals. In conclusion, trapped in the vicious cycle.

Even if they do have the capital, with the increasing demand of health professionals, higher number of graduates and our not so adjusted education system, the quality of these professionals get affected.

This leads to poor dependence on our graduates and hiring of low-level technicians and assistants to carry out a professional responsibility, which in turn leads to a poor quality of healthcare service. This cycle that we are in has already affected many [healthcare professionals] and continues to do so.

We have physicians, pharmacists and nurses who are not willing to work with each other for the betterment of the patient.

Medicine is such a huge field that requires years of knowledge and practise and even then, they may have just specialised in a single area. Yet a recent graduate will not consult other colleagues, medical books and journals. Why?

Is it because the patient will “talk” about him/her not knowing to others? Well, I cannot completely have an answer to that; maybe it’s just the attitude of young professionals. Some of these “concerns” have a cultural notion to it, we live in a society where a physician or any healthcare professional “needs to know everything!”

Try and ask an accountant if they know the latest accounting standards, and they will surprise you with the answers.

They shall clearly tell you these are regular updates and sometimes we don’t even use them, and yet in a such a diverse field of medicine, “they” expect that you must know everything about medicine. All these are interconnected to one another, and without a change of perception first, we shall not move further.

You could change this attitude and work with a small group of multi health diverse individuals in the hospital who can really consult each other and have better therapeutic outcomes.

Quality matters and not quantity. I also believe that hospitals should be headed by individuals who have studied ‘Hospital Management’ as a profession and not leave it to be led by a doctor or professor who has mastered surgery or internal medicine.

They are good in their field, probably best but when in comes to management, they may not have enough expertise to manage a hospital in the best possible way.

Having certain cadre as the head may also lead to bias when making certain decisions. We would really benefit from an independent knowledgeable leader in our institutions.

This for me, coupled with an attitude change is the starting point for breaking this cycle.

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Breaking the silence on infertility

Monday February 18 2019

 

By Hellen Nachilongo @musanachi60 hnachilongo@tz.nationmedia.com

In many cultures, including in Tanzania, women who cannot bear a child, suffer discrimination and stigma. Our culture demands that, for a woman to be socially acceptable, she should bear children.

For example, 39-year-old Mama Boniphace’s husband was pressurised to file for a divorce by his family because she couldn’t conceive.

Married in 2010, Mama Boniphace was ridiculed and discriminated from family affairs for six years because she was deemed infertile. “My in-laws made me feel worthless and there came a time I lost hope, in everything, including my marriage. I was convinced by my in laws that I didn’t deserve to be a mother because for six years we tried but I couldn’t get pregnant,” Mama Boniphace narrate to Your Health.

Upon medical consultation, she was told her uterus was not in position and that her fallopian tubes were blocked that needed a surgical intervention. She was also put on medication. Though she was blessed with a baby boy three years ago, Mama Boniphace says that she cannot forget the pain of discrimination and mockery she went through that has changed part of her completely.

Infertility, the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse, affects at least one in four couples in developing countries.

In an article published in the World Health Organisation (WHO) website on ‘the agony of infertility’, it said;

Although male infertility has been found to be the cause of a couple’s failure to conceive in about 50 per cent of cases, the social burden “falls disproportionately on women,” according to Dr Mahmoud Fathalla, previous director of the Special Programme of Research, Development and Research Training in Human Reproduction based at WHO. “When a couple is unable to reproduce, the man may divorce or plan to divorce his wife,” he says. Such was the case of Mama Boniphace.

Breaking the barrier

But not everyone is as lucky as Mama Boniphace. 48-year-old Angela Chanila has completely lost hope.

Explaining to Your Health, Ms Chanila said she had moved around many hospitals in the city to seek medical treatment for the past 12 years, but all have gone in vain. “I was viewed incompetent and a burden to the family. So my husband decided to impregnate another woman,” she says.

“Though infertility can affect both women and men but, we are more vulnerable to stimatisation than men. Having struggled for 12 years to look for an affordable treatment, I think there is a need for the government and health stakeholders to come up with affordable infertility services that includes prevention, care, treatment or consultation for couples like us,” Ms Chanila adds.

Infertility affects up to 15 per cent of reproductive-aged couples worldwide. WHO demographic studies from 2004 have shown that in sub-Saharan Africa, more than 30 per cent of women aged 25–49 suffer from secondary infertility, the failure to conceive after an initial first pregnancy.

Tanzania is one of the countries in the African infertility belt that stretches across central Africa from Uganda in the east to Gabon in the west, WHO research determines.

For instance data revealed from Kairuki hospital in Dar es Salaam show that 800 patients who go for medical treatment daily, at least 240 are women with infertility problems and out of those, 12-17 women require infertility treatment, such as IVF.

Despite their importance, infertility prevention and care often remain a neglected public health issue in Tanzania.

According to WHO, for many infertile women, particularly those with problems such as blocked or severely scarred fallopian tubes where surgical tubal repair is either not successful or not advisable, in vitro fertilization (IVF) can help. This technology enables eggs to be fertilized directly by sperm outside the woman’s body, without the egg or sperm having to pass through a blocked tube. The fertilized embryo is then transferred back into the woman’s uterus.

Unfortunately for most women in developing countries, infertility services are not widely available and IVF is unaffordable. The cost can range anything between Sh10 million to Sh5 million. Understanding this gap and neglect, Kairuki hospital are in the process to establish a fertility centre to provide an In Vitro Fertilization (IVF) services to women, which remains a limited treatment option in the country.

Speaking during an event to commemorate Hubert Kairuki, Kairuki Hospital’s Deputy Director General and Fertility Consultant, Dr Clementina Kairuki, said that they were in the final stages to open a fertility centre that will be located Bunju. She explained that they decided to come up with such initiative after discovering that reproductive health among Tanzanian women was still the biggest challenge in the country.

“Kairuki hospital attends to at least 800 patients every day but, out of that number, 30 per cent are women and 5 -7 per cent of those require IVF,” Dr Kairuki explained.

Explaining further, Dr Kairuki said though the country does not have evidence based data on reproductive health problems, women with infertility issues is quite huge. “About 30 per cent of women who come at the hospital require medical treatment and the treatment depend on how much they are affected. Others come with blocked fallopian tubes while some come with completely damaged ones,” she said.

She stressed that infertility issues can be found in both men and women but number of women with such problems who come at the hospital are higher compared to men.

Some of the factors that cause infertility are fibroids, high blood pressure and cancer.

Through Kairuki Midwifery University, they have already have started training experts who will be specialised in IVF and some experts will come from India, South Africa and China.

Stigma should end

Modesta Kimonga, a pysychologist based at Muhimbili National Hospital (MNH) explains to Your Health on the negative attitude towards childless women. He says that when a couple gets married, they quench to get a child but it becomes difficult when the couple cannot conceive.

According to her, when a couple fails to conceive after marriage, people tend to point fingers at a women even before going to the hospital for medical checkups to find out who has infertility problem among them.

“As you know in most cases, men do not like going for any medical checkups even if they are the ones with a problem,” she said.

She stressed that infertile women feel isolated because they normally fear to be judgeed. “It does not matter whether you are educated or not, in African culture, the social burden of unable to conceive falls on women,” she said.

The issue of infertility is very serious in the country, unfortunately, victims themselves shy away to talk about their situation.

WHO demographic studies also show that in Sub-Saharan Africa, more than 30 per cent of women aged 25 - 49 years suffer from secondary infertility, the inability to achieve a subsequent pregnancy.

The study further elaborated that infertility is a major reproductive health issue for females as well as males respectively. Many couples suffer from infertility worldwide and in Sub-Saharan Africa, which has a cultural preference for high fertility; women shoulder the highest infertility consequences.

It is generally believed that more than 70 million couples suffer from infertility problem worldwide and this constitutes 15 per cent of reproductive aged couples.

Infertility or childlessness is a global reproductive health issue for female as well as male sexes yet often not discussed in public and most of the times neglected especially in an African setting.

According to a PSI Tanzania [a non-government organisation dedicated to improving the health of Tanzanians] report, shows that the reproductive health burden on women in Tanzania is high. A recent survey suggests that the average Tanzanian woman has about 6 children during her lifetime, and that over half of all women deliver at home, without any access to skilled birth care.

Around 10,000 maternal deaths are recorded each year. For every woman who dies in child birth, another five live with chronic illness or permanent disability.

Many women in Tanzania today would like to space or limit the number of children they have.

Only one in five women currently use a modern contraceptive method, even though over half of married women report that they would like to begin using one.

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Why you should not always go for antidepressants

Monday February 18 2019



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Chris sonchrispeter@gmail.com

People have different perceptions when it comes to defining ‘depression’. For quite some time now, majority of Tanzanians haven’t acknowledged depression as a serious condition.

Statistics reveal that a lot of youth have died in silence by committing suicide; the very underlying major factor remains to be depression. Close to 800,000 people die due to suicide every year, globally, according to reports from World Health Organisation (WHO). Suicide is the second leading cause of death in 15-29-year-olds. However, my long time concern is how to help people with depression in managing the condition. As a matter of fact, depression comes from variety of factors and how to control it remains different for each.

Pills aren’t the answer

For the longest of time we have preferred different categories of antidepressants as the first and best way to manage depression to our patients, regardless of the different causes of depression. This has eventually turned our people, especially the victims of depression to be more dependent on just antidepressants to seek for relief.

But the big question to both patients and healthcare providers is: “Are the antidepressants always an answer to depression? Are people well aware of antidepressants dependency? Do they really know that there is such a thing called antidepressants addiction?”

My case: Supressing an underlying condition

Few days ago, I attended to a lady in her 30s who looked pale with extreme fatigue. This patient was known with long history of depression due to some social and family issues she had encountered.

During consultation, she confessed that she even had suicidal thoughts multiple times.

She has been through several rounds of antidepressants from other facilities, with no signs of improvement. This patient clearly shows every symptom of depression, but the trickiest part is, even antidepressants were of no help to her.

I ordered laboratory investigations for her, and her results showed that she has iron-deficiency anaemia and very low glucose in the blood, a condition medically known as hypoglycaemia. Prescribing an antidepressant in her case would not do anything about relieving all of the fatigue that she has been experiencing.

She has a long history of depression, but that does not mean it should be assumed that her current episode of fatigue should be attributed to it. I prescribed iron tablets for her and other medications to stabilise her sugar level in the blood. Also we had to coordinate with her primary care doctor for further assessment of the cause of her iron-deficiency anaemia and her hypoglycaemia. We also made a timetable of appointments to monitor her response to iron treatment and continue to assess for psychiatric symptoms.

When she returned for her follow-up, a week later, she started to cry when she expressed gratitude for her relief. She was frustrated that her anaemia and low sugar level in the blood were never diagnosed before and that she was unnecessarily put on many pain medications in attempt to bring relief of the pain.

There are many other physical illnesses that can present similar to how depression is experienced in some patients. It is very possible, from a medical point of view that her depression unknowingly led to both of these conditions. That’s why before the patient jumps to ask for antidepressants, he/she should look out for some other factors that leads to his/her persistent depression and present all those factors to a doctor. So many medical conditions have been the cause, or at least a contributing factor, to symptoms perceived by the patient as depression. It’s wise to look beyond just symptoms and carefully look for cause and contributing factors of the presenting chief complaint of depression.

An antidepressant isn’t always the answer to what appears to be depression.

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How to deal with dandruff at home

Monday February 18 2019

 

One of the problems people face, especially women, is dandruff. An itchy scalp and greasy white spots are the common signs of dandruff.

Semeni Shija, an aesthetician based in Dar es salaam tells Your Health that dandruff is mostly caused by dry scalp, when that is not cared for properly, it ends up with accumulation of dry and dead skin cells which result into formation of dandruff.

She adds, “Another reason which leads to dandruff is dirty scalp. It attracts a lot of germs and bacteria, which result into dandruff because dirty scalp can cause formation of yeast and fungal growth.”

The symptoms of dandruff include white flakes of dead skin in the hair, they are itchy and red, they are usually scattered throughout the scalp.

Ms Shija advises that one can take care of their scalp while at home by using natural remedies or using the right products to avoid dandruff. “Dandruff is harmless but it can get embarrassing and itchy, so it is better to take care of your scalp before the condition worsens. There are natural ways that can be used to avoid dandruff,” she says.

According to Ms Shija, the best way to avoid dandruff is by using the right shampoo, conditioner and oil for the scalp, she also says the scalp should be kept clean always in order to avoid yeast that cause dandruff.

“Some people are very dirty, they don’t wash their hair often, this is not good for the scalp because it produces germs and pimples which cause itching,” she says.

She advised on washing hair twice a week, and for those with artificial hair, to avoid staying with them for a long time. Keep the scalp wet most of the time by using the right oil or conditioner.

1. Coconut Oil

Coconut oil improves scalp’s hydration and prevents dryness which results into dandruff. It also help into treating eczema, a skin condition which may result into formation of dandruff. Coconut oil and its compounds also contain antimicrobial properties which treat fungus that cause dandruff.

2. Use of aloevera

Alovera has anti-bacterial and anti-fungus properties, which reduces inflammation and helps protect against dandruff. Most of us have an aloevera plant at home or at our neighbour’s. Try to apply it once or twice a month.

3. Wet scalp

Make sure the hair or scalp is always wet. One of the causes of dandruff is dry scalp; when the scalp is dry, it is easy for bacteria to go through the skin and create an environment for them to live, it is better make sure your scalp is always wet by spraying rose natural water or pure water.

4. Avoid chemicals

Products are more safe when they are used natural and they don’t have chemicals that can damage your skin. Some ready-made products have sulphate or mineral oil which are bad for the hair and scalp.

5. Hair treatment

Blockages on scalp can give way to many problems including pimples on scalp or irritation. It is better to do a scalp detox in order to clear these impurities. There are two types of hair and scalp treatments; one is moisturiser and second is protein. This can be done at least once in a week or once in two weeks. In doing this, we should use the right kind of shampoo and conditioners to keep scalp fresh, clean and free of problems.

6. Use of apple cider vinegar

Apple cider vinegar has ant- inflammatory, anti-bacterial and antifungals properties which reduce itching caused by dry skin. Frequent use of apple cider vinegar can relieve an itchy scalp and prevent the skin from dandruff.

7. Meditation

It is not a surprising matter to do activities which relieve stress such as meditation, this is the best and effective way to eliminate itchy scalp caused by anxiety or eczema.

Dandruff can often be a chronic condition but it can be controlled with the proper treatment such as non-medicated shampoo, massaging scalp firmly and then rinsing well.

A shampoo removes flakes, reduces oiliness and prevents dead skin build-up.

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Cancer’s bitter secret: Abandoned by family

Monday February 11 2019

 

By John Namkwahe jnamkwahe@tz.nationmedia.com

Nothing hurts the most than your own family abandoning you at the time of need, and 21- year-old Rajabu Mohammed knows this too well. He is the first born in a family of four children and he is one among 20 or more abandoned [by family] cancer patients at Ocean Road Cancer Institute (ORCI).

He describes himself as an adventurous person who loves people and being social. He narrates his story to Your Health.

“I am a former Head Prefect at Kanga Hill Secondary School in Mvomero District, Morogoro Region. I developed oesophageal cancer in 2017 when I was in form four,” Rajabu tells.

OESOPHAGEAL CANCER

The illness develops when abnormal cells in the food pipe (the tube that carries food from the mouth to the stomach) grow in an uncontrolled way.

“It all started as an on and off earache around May of 2017. I then started experiencing weakness. I was forced to drop out of school several times due to the illness,” Rajabu recalls. It was due to this reason, he failed the form four national exam.

“I started having dizzy spells towards the end of September and that progressively got worse until I started feeling pain when swallowing food. I was purposed to go for a check-up which did not happen because my family did not have money to afford the treatment costs,” he says.

Since Rajabu’s ill-health, his father has never paid attention nor paid him a visit, let alone taking responsibility to take care of him. “I also have other sisters and brothers from the same father but different mother. But they are minding their own business,” he says.

Rajabu’s mother had to sell 10 timber trees which earned her Sh350,000, but the money was not enough to cover his treatment costs so he had sought further financial assistance from his uncle.

“But he said he did not have the money that time. I started to lose hope. My whole body was aching and I was feeling very cold,” Rajabu says.

His mother had to seek further help from her father (Rajabu’s grandfather) who contributed some extra funds.

“Many thanks also to my aunt for her support but then she could not push the check-up any further,” Rajabu tells.

When things got worse, Rajabu decided to go to a private health facility in Dar es Salaam to see a doctor who said he had to do tests to ascertain what was wrong.

TEST RESULTS

The results took some time to come out. He had to wait. He was laying on the hospital bench close to his mother. “She looked more worried than I, but she didn’t want me to notice it. I got my results back which showed that I had a tumour in the oesophagus. So the doctor suggested we should go to the Muhimbili National Hospital (MNH) to take it for biopsy to determine if it was cancerous,” he says.

At MNH, Rajabu had to be admitted, something which he opposed to do because he only came in for a check-up. He, therefore, underwent several tests, including CT scans and X-Ray scans.

“I got my results back, which showed that the tumour was cancerous. The doctor explained that she would transfer me to the ORCI for further specialised cancer treatment,” Rajabu further tells.

TOUGH ROAD

He was referred to the cancer facility. “I had a lot of hope. I began chemotherapy in November last year, and as of now, I have undergone several sessions,” he says.

But during his treatment time, Rajabu’s mother and aunt abandoned him in the hospital.

“Their pocket money had finished. I couldn’t blame them. It was a very depressing moment for me,” Rajabu continues, “What hurts me most is to see my father ignoring me all these days since I developed the disease as he has neither called me nor sent me words of encouragement.”

HOPE

Rajabu has always been passionate about becoming a successful business tycoon. Though he knows in order to achieve this, he must win this battle. The field he is passionate about is agriculture.

“I have never been employed in my life and it is my priority. I want to be free from cancer to run my own business. I believe one day I will achieve this,” Rajabu is full of hope.

CANCER IN MEN

The oesophageal cancer is the leading disease affecting mainly men followed by Kaposi Sarcoma (KS) and Prostate cancer, revealed the ORCI Executive Director Dr Julius Mwaiselage when he spoke to Your Health over the telephone.

CANCER TREATMENT

The National Health Policy stipulates that all cancer patients visiting the ORCI should access free treatment.

Despite the existence of the policy for free treatment, Rajabu discloses that he is sometimes forced to dig in his pockets to pay for medicines at the institute.

“It is true that medicines are provided free of charge, but sometimes we are instructed to buy other medicines from the pharmacy,” says Rajabu while seated on the hospital bed during the interview with Your Health.

Responding to that, Dr Mwaiselage elaborated that at least 95 per cent of the inpatients at the institute have access to cancer medicines and other medical services free of charge.

He further added that those inpatients and outpatients who use health insurance cards have access to cancer medicines by 100 per cent at the institute.

“The government through the Medical Store Department (MSD) supplies all the essential cancer medicines and medical supplies here at the institute, therefore all the medicines are available,” Dr Mwaiselage said.

He added, “We have also opened the drugstore here to cater for inpatients and outpatients who demand to buy other types of medicines apart from the cancer drugs like antibiotics to treat infections.”

FOOD AND ACCOMMODATION

Dr Mwaiselage further revealed that the cancer facility is currently offering free food and accommodation services to 240 cancer inpatients.

He also commended the stakeholders for their continued support to complement the institute’s commitment to delivering high-quality cancer treatment in the country.

“We spend over Sh100 million per year, an average of Sh12 million per month for food and other expenses like transport fees for some abandoned patients who have been discharged from the hospital,” says Dr Mwaiselage.

Referring to the rapid growth of abandonment of patients at the ORCI, Dr Mwaiselage elaborated “The problem starts from the regional referral hospitals where these patients are being taken for initial treatment before they are being transferred here,” he continues, “The doctors in the regional hospitals do not inform the patients’ relatives that the cancer treatment involves a prolonged medication, this is why when they come here, the relatives find it difficult to stay and take care of their patients for that long.”

According to him, the cancer treatment involves between 4-8 weeks of prolonged medication.

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I’ve been cancer-free for four years

Monday February 11 2019



Cancer survivor Godfrey Mwiti. PHOTO | COURTESY

Cancer survivor Godfrey Mwiti. PHOTO | COURTESY 

In November 2012, Godfrey Mwiti was all set to start his industrial attachment in catering at the Sentrim Lodge, Maasai Mara.

A few weeks before he began his attachment, Godfrey began experiencing some mild headaches and nausea. His condition worsened as soon as he arrived at the lodge. Alarmed, he decided to seek medication at a nearby clinic.

“I sought medication at Sekenani Market, which was a walking distance from the lodge. After several tests, I received treatment for typhoid and malaria. I took the medication as prescribed but there was no improvement. I missed the training sessions because I was too weak to leave my room.”

As his health deteriorated, Godfrey summoned the little strength he had remaining and decided to seek a second opinion from healthcare centres in the area. He hoped to get a diagnosis of what was ailing him but his efforts proved futile. It was at this point that he decided to go back home to his family in Meru.

DIAGNOSIS

“In February 2013, my elder brother accompanied me to a private hospital where I was informed that there was a possibility that I had a brain tumour. I was then referred to Kenyatta National Hospital where I underwent an MRI scan. The results revealed that I had three malignant (cancerous) tumours in my brain. I was diagnosed with desmoplastic medulloblastoma. It was all so surreal, thankfully my brother was there to give me emotional support.”

Godfrey began his treatment immediately after the diagnosis. He went into theatre for surgery to have the tumours removed. The operation was successful and he was discharged from the hospital in April 2013. However, the surgery had some side effects that affected his vision and motor skills causing him to stagger when walking. His hearing and taste buds also became distorted. But Godfrey was determined to get better and in November 2013, he began the long and painful journey of radiotherapy treatment.

“Initially, I was to have 28 sessions but my doctors increased them to 44 after just 15 sessions. These sessions left me so weak. Nausea and sporadic vomiting was the order of the day. I lost a lot of weight and became bald. It was a terrible experience. All in all, I completed the sessions in January 2014. I went back to college and picked up from where I had left. However, I had to go for regular check-ups.

REMISSION

“A routine MRI scan in April showed severed parts in my brain. I was terrified that the cancer had recurred. My doctor reassured me that it was just an effect of the radiotherapy and that the cancer was gone. I was greatly relieved.

“Although I was in complete remission, my body was not strong enough for the strenuous work that comes with a career in catering. In January 2017, I went back to school to train as a technical teacher. I fit in perfectly.”

Today, Godfrey teaches at the National Youth Service School of Catering in Gilgil’s paramilitary training college. In addition, he has written a book based on his cancer journey, titled: It Is Well: My Struggle with Cancerous Brain Tumours and a Glorious Healing Process. He hopes to publish it soon.

“The fear of the cancer recurring is definitely there, but my faith is stronger than that. Cancer taught me to be positive over the years. The stagger is almost gone and my vision has greatly improved over the years.

“Cancer is not a death sentence. It is curable. Early diagnosis, as well as being positive and being surrounded by the right people, helps a great deal. My advice to other cancer patients would be to never give up on themselves. Prayer and trust in God makes everything simpler. It is also important to eat well, exercise regularly and always go for check-ups.”

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Together we can beat the disease

Monday February 11 2019



Dr Heri Tungaraza

Dr Heri Tungaraza 

By Dr Heri Tungaraza

The 4th of February has never been an ordinary day in the fight against one of the most difficult diseases to beat.

Cancer has been dubbed many names, the most defining one according to me is ‘emperor of maladies’, coined by the the author and oncologist, Siddhartha Mukherjee.

On this day, people from all over the world and from all walks of life affected and unaffected by cancer came together to celebrate the lives of those that have succumbed to the disease but even better, to cheer those who have beaten it. It’s a day to remind each other of the battle that still lies ahead and pick each other up.

In 2018, cancer claimed lives of around 9.6 million people globally, and it stood as the second leading cause of death. A big chunk of these deaths, around 70 per cent, occured in developing countries like Tanzania. The current pattern paints a picture of cancer as a leading cause of death in poor countries, demystifying the myth that cancer is only for the rich.

The Tanzanian reality

World Health Organisation (WHO) reports that 30 per cent to 50 per cent of cancer deaths can be prevented by modifying or avoiding its major risk factors. These include quitting smoking, maitaining a healthy body weight, reducing alcohol consumption, exercising regularly and combating infection related issues by screening, prompt treatment and vaccination.

As a country we must continue to remind each other that cancer has touched every home like AIDS did.Today we must acknowledge that cervical cancer kills more women than any other cancer in the country and the same can be said for prostate cancer among men.

Though deaths due to cancer have plummeted globally, in Tanzania the scenario is different.

In total, we diagnose around 42,060 new cancer cases every year and unfortunately 28,610 do die in the same year. This means more than half of those diagnosed with cancer die in Tanzania. This picture does not represent cancer all over the world, but rather says more about our health system and lifestyle of our people.

We have taken strides, more needs to be done

The Tanzanian story of cancer though depressing like many parts of Africa, we have made a few steps in the right directions.

We have more basic chemotherapy drugs now available under and beyond the scheme of free cancer treatment for all. As more government facilities start offering cancer care including Muhimbli National Hospital (MNH), which poised its first bone transplant, more private players have joined in the fight. According to the Ministry of Health, more than 1000 patients received treatement in the private setting in Dar es salaam and outside.

Even more promising is we have three linarc machines, state of the art radiation equipments with two or more belonging to the government. This has insured increased quality in cancer care in the country with the hope of reducing deaths and morbidity for those inflicted with this monster. We have increased our number of experts in the area, boasting of many oncologists today than ever before. I’m optimistic that one day we will win more battles than we are today against cancer in Tanzania.

The road ahead

We still have challenges that hinder our desired progress. Financing of the cancer care is still a puzzle. Cancer is expensive and globally it was estimated in 2010 to cost the world a staggering $1.16 trillion. Embracing the fact that cancer care is expensive, we need to gather efforts and speak with one voice for universal health care. Health insurance for all will enable easy access to cancer care as well as screening services and hence reduce late stage cancer.

For cancer care to be effective in controlling the burden in our country, it has to be affordable and accessible to all and in the same spirit of never losing hope.

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Why smoking is woman’s worst enemy

Monday February 11 2019

 

By Paul Murungi

The growing trend of women smoking is a concern to health experts. Charles Baguma, a coordinator at Uganda Health Communication Alliance, says according to a Global Youth Tobacco Survey done five years ago by the Centre for Tobacco Control in Africa, young females have overtaken their male counterparts in the initiation of tobacco use.

The report further notes that more female university students were learning how to smoke the pipe and consume tobacco products such as shisha and cigarettes, among others. Baguma says most females are influenced by peer groups to smoke while others think it is fashionable.

Dr Brian Musinguzi of Total Medical Centre in Luzira, says: “Tobacco contains nicotine which is an active component in affecting one’s health. But also, during smoking, carbon monoxide is produced which competes with oxygen,” says Dr Musinguzi.

He adds that the consequences are short and long term depending on how much one is engaged in using tobacco and how fast the nature of the tobacco product acts on the body.

Pregnancy problems

“Chemicals such as nicotine and carbon monoxide are passed from pregnant mothers through the blood stream to the foetus. These toxic chemicals may lead to preterm delivery, low birth weight and miscarriages,” says Dr Musinguzi. He adds: “A pregnant woman who smokes has a high risk of miscarrying and other risks such as placenta abruption (when the placenta separates from the uterine wall).”

He adds that babies born to mothers using tobacco experience colds, earaches, respiratory problems and illness.

Infertility

Is a baby part of your future plans? Dr Aloysius Rukundo of Mbarara University of Science and Technology, says since most women who use tobacco products are in a reproductive stage; there is a greater risk of not ovulating. This is because nicotine interferes with the functioning of the fallopian tubes and can hinder an egg from travelling normally to the uterus.

Birth control issues

Smoking while using hormonal methods of birth control such as oral contraceptives may result into blood clots, heart attacks and strokes, according to Dr Musinguzi.

“When you combine the effects of nicotine with those of birth control, there is an increased chance of stroke and heart attack, because nicotine causes blood pressure to rise and the heart rate to accelerate; and pills add more stress to the blood vessels because of extra estrogen,” he says.

Risks in breast feeding

“If a breastfeeding mother smokes, then the child is a passive smoker. This results into a direct negative impact on the respiration of the baby with diseases such as pneumonia,” Dr Musinguzi explains.

He says since nicotine stimulates the release of more adrenaline in the body. This could lead to an increased heart rate of the child which is disastrous. “That’s why you hear cases such as a child having a ‘hole’ in the heart,” he notes.

Premature menopause

Dr Rukundo says smoking leads to abnormal bleeding, irregular periods, menstrual cramps and premature menopause.

“Heavy smoking increases a woman’s risk of early menopause, especially if one begun it early in life. Having early menopause is because nicotine decreases and interferes with blood supply to the ovaries,” he explains.

For irregular periods and menstrual cramps, he says this is as a result of a decrease in the amount of oxygen available for the uterus.

Cancer

Women who smoke are more likely to acquire cancer including cervical and breast cancer. “Most tobacco chemicals contain carcinogenic elements. Throat, lung and oral cancer are common among people who smoke. The coating of nicotine in lungs also destroys normal cells as well creating breathing problems,” Dr Rukundo explains.

He also notes that since most tobacco products are now designed for chewing, tooth decay, stained teeth and smelly breath is a major effect among tobacco users.

This, he says results into poor oral hygiene which is bad especially for women.

Expert advice

“Women and men must know that there are no health benefits from tobacco. And the big worry is women spend more time with children which may lead to secondary problems on children,” says Charles Baguma.

Dr Aloysius Rukundo of Mbarara University of Science and Technology, says women should not expose tobacco products to children since it may result in mental health problems in future.

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It should not be this hard to find right specialists

Monday February 11 2019

 

By Nelly Bosire

A friend asked me to recommend a paediatric neurologist in Nairobi. The one who was attending to them was so busy that it took at least three months to get an appointment. Clinic visits with the specialist were frustrating; there were so many patients, that one had to wait till as late as 11 in the night to be seen.

I could not imagine a waiting room full of babies with cerebral palsy, epilepsy, attention deficit and hyperactivity disorder, stroke and autism, having to sit patiently for hours.

However, the neurologist I knew off the top of my head was the very same one they were opting out of.

I called a paediatrician for recommendations, and she gave me just two more options.

A search on the Kenya Medical Practioners and Dentists Board website yielded only six paediatric neurology experts to serve more than 20 million children who may need their services.

They are mostly based in Nairobi and its environs, so children in need of their services must travel to them. So much for access to healthcare!

When I asked a paediatrician friend if she would be interested in pursuing paediatric neurology in view of the glaring specialist gap, she said she would not venture into such a depressing field, waking up every morning to deal with difficult diagnoses, frustrated parents who don’t know what to do and babies teetering on the edge in the intensive care unit.

That’s not how she envisioned spending her days. It would drive her over the edge.

In my short stint as a medical officer intern at the paediatric unit of a national referral hospital, I saw what she meant.

There were babies who spent half their lives in the wards. There were little ones who convulsed non-stop while we pleaded and bargained with the intensive care unit to miraculously find them a bed so they could be put on the cardiorespiratory support they needed.

WE CAN TRAIN OUR OWN

There were the delicate newborns with meningitis who would leave us biting our fingers wondering whether they would survive the infection and what mayhem the complications would inflict on their future.

I have met parents with babies with autism who will do anything to relieve their little ones of the burden of the diagnosis. They fly to all parts of the world seeking care. They enroll for all clinical trials, hoping for some improvement.

They spend millions to pay for experimental treatments that may not have demonstrated much by way of results.

Caring for babies with neurological conditions is heavily taxing for the family -- physically, emotionally and financially. The stress has broken families and caused untold pain.

To add insult to injury, most medical insurance covers will not cater for these conditions and when they do, the cap on expenditure is not adequate.

These babies face the double tragedy of not having access to care due to inadequate specialists. A doctor cannot be forced to take up a speciality just because there is a gap.

However, the government can mitigate this by making it attractive for young doctors to consider studying in fields with shortages.

The Ministry of Health has successfully done so in the past by providing conditional scholarships in areas such as anaesthesia and ophthalmology and this has seen the numbers of specialists increase markedly.

It was thought that bringing foreign doctors would help, while buying time to train our own. However, there is need to review the real gaps and plan accordingly.

We can train our own super-specialists. We have enough patients, adequate technology and medical schools. The challenge is to help these schools grow their capacity to train the very highly specialised skills that we are still seeking abroad.

Existing specialists should also mentor and train young doctors and help them get scholarships, from wherever in the world they are, and come back home to help our own.

It is not right that we have only one emergency medicine specialist in a country overrun by boda boda accidents, or one dental radiologist after all these years of training dentistry in Kenya. It is a sign of poor planning for human resources for health.

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Cancer Day: Cancer treatment: Beating the long waiting time

Monday February 4 2019

 

By John Namkwahe @johnteck3 jnamkwahe@tz.nationmedia.com

21 years after her cancer diagnosis, 36-year-old Elimina Ndunguru, resident of Ruvuma, recalls the first time she visited the Ocean Road Cancer Institute (ORCI). It was in 1997 when she first saw the stumpy white structure facing the Indian Ocean.

But once Elimina was inside, the hospital took on a different atmosphere. She tells Your Health, “It was crowded, there was no place to sit and I waited more than three hours to just see a specialist, let alone the treatment process.”

In the last three years, the Dar es Salaam based- institute used to be overwhelmed by cancer patients from all the regions across the country, including patients from cross-border countries like Malawi and Kenya.

A recent database showed that at least 5,529 cancer cases were recorded at the institute in 2016, Dar es Salaam region carrying the biggest burden of cancer compared to any other regions in the country.

Due to the burden, long patient waiting times are a big problem in healthcare in Tanzania especially in public health facilities due to the notion that they offer treatment at a lower cost compared to private hospitals.

According to a report published by the World Health Organisation, chronic shortages seemed to be the norm in the hospital [ORCI] with wards being crowded, often 10-12 beds massed together in a small room, there is no air conditioning, and some of the narrow beds are occupied by two patients. It further said, “Certain critical drugs for chemotherapy were missing at the time of the visit, and where the only two radiotherapy machines are working over-time; according to one of the radiotherapists, the hospital would need six machines to cover actual demand. The machines also break down often, making treatment all the more difficult.

On the positive side, the hospital does employ a bio-engineer to maintain and fix the machines when there are technical problems.”

In spite of the emergence of cancer as a serious public health issue, the country has only two cancer hospitals - a large population of this relying on ORCI.

Things are different now. What changed?

Cancer is on the rise, globally, with 9.6 million people worldwide are estimated to die from cancer in 2018. Tanzania is not an exception. According Dr Crispin Kahesa, ORCI’s Cancer Prevention Services director, the number of cancer patients they receive in the hospital has risen from over 4,500 recorded in the last three years to 7,300 in 2018.

Out of those cases, one of them was Elimina’s. During the visit [to ORCI] three days ahead of World Cancer Day that falls today, Elimina was there for her routine treatment.

When she was discharged in 1998, she was told to visit ORCI yearly for consultation and treatment.

But things seemed a little different during the recent visit than what Elimina had recalled. People were seated on benches waiting for their turn, it was not crowded and importantly there were no queues.

Walking up to Elimina, the hospital was decorated with pink and white balloons to commemorate the big day ahead. The ward beds were spaced with each patient having their own bed.

Elimina is smiling. “I’m a cervical cancer patient and have been visiting the hospital for my radiation therapy sessions yearly. Things have changed so much, from waiting just minutes or an hour to see my specialist to the not-so long waiting time for the treatment,” Elimina confesses.

Things took a different turn last year.

Due to the growing demand, Minister for Health, Community Development, Gender, Elderly & Children Hon. Ummy Mwalimu, last year, heightened to speed up installation of radiation therapy machines at ORCI with a view to enhancing treatment services. Published in The Citizen last year, Dr Julius Mwaiselage, hospital’s executive director was quoted saying, “We will be installing two linear accelerators and one CT stimulator.”

Dr Kahesa further adds on to this that they can now attend to about 100 chemotherapy patients per day from 40 and about 220 radiation therapy patients per day from 160.

“Availability of medicine and other essential basic needs like food and accommodation have improved here. Many thanks to the government,” says Elimina, as she prepares herself for her radiation therapy session.

Reaching to many cancer patients

Dr Kahesa says, advances in imaging technology has made it possible for the institute to offer cancer treatment more precisely reaching to a bigger number.

Availability of medicines and medical supplies at the institute has improved from 4 per cent in the last three years to 87 per cent in 2018.

The improvement achieved after the government recently increased the budget for the institute from Sh700 million to Sh7 billion, according to the hospital management.

Dr Kahesa explains, “ORCI offers numerous cancer treatment services including diagnostic imaging, chemotherapy, radiotherapy and palliative care services.” Following the advances in imaging technology, the institute was determined to reduce congestion of patients who seek treatment at the institute.

He adds, “Our target is to keep improving cancer treatment to cater for more patients in the country.”

Dr Kahesa further highlighted positive impact of the installation of the equipment in the hospital, saying at least 70 per cent of cancer inpatients and outpatients were currently accessing radiotherapy service.

He also commented that the hospital is currently having at least 25 cancer specialists, citing that in the last three years the institute was hit by shortage of specialists.

Let’s double the efforts

Cervical and breast cancer are still the leading cancer diseases in Tanzania affecting most girls and women. However, the senior cancer specialist, Dr Kahesa expressed optimism saying the newly launched cervical cancer vaccination for girls aged 14 would help to prevent girls from developing the illness.

Dr Kahesa also said doubling of efforts is necessary to educate Tanzanian population on importance of conducting regular medical check-up, insisting that early detection of cancer saves a life.

This year’s Cancer Day celebrations mark the launch of the 3-year ‘I Am and I Will’ campaign aimed at urging for personal commitment and represents the power of individual action taken now to impact the future.

This includes making healthy lifestyle choices that include avoid using tobacco products, getting plenty of physical activity, eating a healthy diet, limiting alcohol, and staying safe in the sun.

And also, know about signs and symptoms of cancer and early detection guidelines because finding cancer early often makes it easier to treat.

As part of the celebrations, the organisation and people in the world unite to raise awareness about cancer and work to make it a global health priority.

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Cancer Day: How far have we come to fight cancer?

Monday February 4 2019



Dr. Christopher Peterson

Dr. Christopher Peterson 

Happy world cancer day my dear readers! I dedicate today’s greetings mostly to our loved ones who are courageously fighting this disease, and to the souls that cancer stole their breaths before this day.

Yesterday, a friend of mine who is a cancer survivor posted a photo on his social media handle with a big smile on his face captioning: “Today is my last chemotherapy session and I can’t wait to celebrate tomorrow. Off you go cancer.”

You can imagine how this day means to cancer survivors like him, whom after several torturing rounds of chemotherapy, he is now through and it obviously feels like he has gotten his life back.

How far have we come?

According to statistics, in previous years, cancer was more of a death sentence! It was very rare for a cancer patient to survive. Treatment modalities were very few, compared to the present scenario.

Survivorship was poor due to not-so advanced treatment options and poor awareness of the diseases among the people themselves; but today, my friend whom I mentioned about, represents thousands of cancer patients who successfully overcame cancer.

This is thanks to the various initiatives taken by our associated institutions for investing in researches and other ways of disease eradication. At least even though the disease has constantly been there, the survivorship has dramatically increased in recent years.

We shouldn’t sit on our laurels

This brings a clear picture that we have so far made a significant step in fighting cancer, but there are always questions that hit us; are we anywhere close to winning the battle against cancer? Does our initiatives to fight cancer really count? If not, where are we going wrong? If yes, do we continue with the initiatives?

For quite some time now, I have looked at cancer fighting strategies and realised that we still have a mountain to climb. Let’s not sit on our laurels. Yet at times I wonder if the approaches we have been using so far will enable us to turn victorious in this war against cancer eradication.

It was encouraging to learn, early last year that our country, Tanzania had for the first time achieved a historical milestone to roll out the Human Papillomavirus (HPV) vaccine.

This vaccine protects and prevents against the types of HPV that includes cervical cancer, the second most occuring cancer among women globally.

As a medic I strongly applaud this initiative by the ministry of health.

During the first ever ‘MwananThought Leadership Forum’, held last year on non-communicable diseases, I asked the Ministry of Health, Community Development, Gender, Elderly and Children, Hon. Ummy Mwalimu just how far the rolling out of HPV vaccine was successful.

She confessed that although it had few challenges, for instance, rising of misconceptions among the people on the effectiveness of the vaccine, which I believe, it was due to illiteracy and lack of knowledge, she assured that the campaign was more than 60 per cent successful.

On this cancer day however, I want to give a kind reminder to the government that I remember the same last year, the government declared to do a cancer registry as part of a new health policy to manage the disease.

The country hoped to use the registry to map areas where cancer is most prevalent in order to allocate resources accordingly. I’m convinced this cancer registry would be impactful and I humbly ask the government to reconsider about implementing it.

On this cancer day, I would like to remind readers once again to eat healthy and exercise daily.

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Herbalist recalls cheerful moments during surgery

Monday January 28 2019

 

By Gladys Mbwiga and Syriacus Buguzi

Dar es Salaam. Being a herbalist for decades now, Mr Hussien Hoza was always intrigued by what medics usually do to heal their patients, but, he desired for one more thing—to behold the surgeons at work in an operating room; with scalpels cutting through the body, diagnosing and treating a patient.

Hoza, 75, had undergone a series of surgeries in the past but, never had he got a chance to witness—by his naked eyes—the intricacies of surgery, only until last week.

Last Monday, he faced the knife on his arm while awake at the Muhimbili Orthopaedic Institute (MOI), thanks to the institute’s newly introduced technique used to control pain during surgery, known as reginal block anaesthesia.

It was now time for him to witness—in real time and on his body—as the surgery process went on.

But, it was another moment of progress for MOI as it introduced a service that, if rolled out in most other hospitals, could boost surgical care and pain management.

Only until this year, not many Tanzanians were able to access this service and it wasn’t popular. The scarcity of anaesthesiologists has contributed to its being a rare procedure in Tanzania.

With less than 30 practicing anaesthesiologists serving over 55 million people in Tanzania, the efforts to training more of these experts remain wanting.

A 10-day training by experts from the University of Latvia at MOI last week is geared at creating more experts in the field, said the MOI executive director, Dr Respicious Boniface as he announced the commencement of regional block anaesthesia services at the facility.

Mr Hoza is one among those who have undergone surgery under regional anaesthesia at MOI, setting a stage for more patients.

How it’s done

Patients with a surgical problem are operated on, by numbing the body part that requires surgery. The nerves that supply to it are blocked.

At MOI, where it was recently announced to begin, experts say it’s being carried out in a more advanced way, whereby doctors use Ultra Sound technology to target and block the nerves in real time.

“With this kind of anaesthesia, if the surgery is performed successfully in the morning, a [...] patient could go home soon after surgery and return to the hospital only for check-ups,” says Dr Albert Ulimali, an expert in anaesthesiology at MOI.

Hoza’s new experience

Hoza remained awake throughout the surgery in which doctors were removing an implant from his ailing left arm. The implant had been placed during previous surgeries to treat his arm.

“I could see… [the surgeon] cut through my arm, push the bones and rearrange everything…later I left the operation room as if nothing had happened to me.”

“I was waving at the doctors with my right hand. I think I was excited as I came out of the operating room,” recalled Hoza as he went on to narrate his past ordeal.

“For the past three years,” he says, “I have had trouble with my arm and doctors had to operate on me twice, but I was always unconscious during each surgery,’’ says Mr Hoza, a resident of Tanga Region.

“I desired to know what happens during surgery. Contrary to what I was already used to…this time around, when I arrived at the hospital, my doctor assigned me to experts from abroad who told me that I would go through a whole new surgical experience,” says Hoza.

“It’s now three days since I underwent the surgery and I can lift up my arm, something that I haven’t been able to do in a very long time,” he said, as he sat on his hospital bed, flexed his arm and took a breath to narrate his tribulations to Your Health.

His story of illness dates as far back as three years ago, when he sustained injuries in an accident and another incident last year when he was attacked by a donkey on the streets in Tanga town.

“Many years ago, a load of 15 tons fell on me and broke some of my ribs and collar bones,” he began narrating.

“Since then, my fingers on the left hand lost function. I stayed for a very long time without being able to hold things,’’ he says.

“But things did not just end there, last year, as I walked on the street on my way from the mosque, I was attacked by a donkey.”

“The donkey knocked me and I fell on the ground…and it started biting me all over my body. I was only rescued by a Masai man who showed up and struck the donkey’s nose and that is when the donkey finally let go.”

“I left the scene with my wrist on the left arm…I could not lift my arm anymore.”

Hoza was then referred from Tanga to Muhimbili National Hospital (MNH) where he been receiving since then. Thanks to the growing investment in anaesthesia services in Tanzania, he has been able to undergo a better surgical experience but countrywide efforts to improve anaesthesiology are still needed.

Reports show that most anaesthesia and intensive care is carried out by nurses, or by partially trained Anaesthetic Officers in Tanzania.

Details obtained from the Muhimbili-Karolinska Anaesthesia & Intensive Care Collaboration show that the knowledge and skills of these staff were largely gained during their initial vocational training.

A lack of in-service training and educational material results in knowledge that is old and out-of-date, says their report titled: Anaesthesia & Intensive Care in Tanzania, published on http://www.mkaic.org.

Working alone, without supervision and incentives, the anaesthesia practitioners are poorly motivated, it says.

Neglect from policy makers and a lack of research capacity means anaesthesia and intensive care is absent from the national health agenda.

Furthermore, old and poorly functional or even absent equipment as well as a limited selection of drugs contribute to the critical state of anaesthesia and intensive care in Tanzania.

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Let us show first responders that we care for them

Monday January 28 2019

They [the first responders] are first at the

They [the first responders] are first at the sites of disaster, but are left to deal with their distress on their own. PHOTO | NMG 

By Nelly Bosire

When terrorists struck 14 Riverside Drive in Nairobi recently, emergency response teams did a commendable job.

Security forces moved in to secure the area and evacuate hostages, and medical teams were on site to provide emergency care to the injured and transfer them to hospital.

The bereaved families require emotional support to deal with the pain of losing their loved ones, while those who were evacuated require psychotherapy to come to terms with the traumatic experience. But who is looking out for our first responders?

The disciplined forces are trained to take a bullet for us; to be the wall between life and death when staring at the end of the barrel.

It is not that they are fearless, but that they look fear in the eye and stare it down, in order to do their job.

Healthcare workers are trained to deal with death every day. It is not that they become numb to it, but rather, they realise that if they do not roll up their sleeves, glove up and get bloody, their patients will surely die. They must suspend their horror at seeing body parts dismembered and fight to put the patient together again.

I was thinking about first responders, and especially Red Cross volunteers, because of my friend Karanja, a young and dedicated man who responded to emergencies as a Red Cross volunteer during the 2007/2008 post-election violence.

Paso, as his friends call him, was stationed in the cauldron – the North Rift – that was boiling out of control. He spent three weeks evacuating casualties and became a near permanent feature at the mortuary.

Death in all colours

Evacuating burn victims from the Kiambaa Church, decomposing bodies from maize fields and youth whose lives had been ended by bullets in informal settlements in Eldoret, he saw pain and death in all colours.

Trying to lift the body of burn victims, the flesh slid off the bone in his grip. He pulled babies from the arms of decapitated mothers who had tried to protect them from the horrors being meted out on them.

While he was struggling to help those in distress, his own family was camped out in the biting cold, at the local police station 100 kilometres away from home. They had lost everything when their house was torched, only narrowly escaping with their lives.

When evacuations were done, Karanja hit rock bottom in one swoop. He fell ill from the underlying unresolved trauma. It took nearly two weeks to restore his physical health, and years to achieve a semblance of psychological peace.

To date, Karanja cannot watch even a simple lancing of a boil. Seeing anything that inflicts pain knocks the wind out of him. Volunteers like Karanja make the majority of Red Cross responders.

Trauma is real

Many are young people well-trained in emergency response, and who will move to other careers in future. They may not have the benefit of the mental cushion against the trauma that comes from the emergency response work they do.

The trauma they suffer is real. The scenes they must deal with evoke real horror. They get to take in the whole scene and not just snapshots as the rest of us will. They carry these images home on a daily basis and as they go about their business.

We highly commend the Kenya Red Cross for the massive efforts they put to stand in the gap for us as Kenyans. They are singularly holding together an entire service (emergency response) that should be a government function under the Ministry of Health.

We hail the young volunteers, who give their all, to serve us in our times of need; sacrificing their youth for a lifetime of deep mental scars.

It must not be in vain. We must support them by providing a proper framework for debriefing these young souls regularly as they carry out their mandate.

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Pregnancy malaria vaccine passes test in humans

Monday January 28 2019

 

By Janet Otieno-Prosper


The real sneak thief causing vision loss among Tanzanians

Thursday January 24 2019



Dr Lugano Wilson

Dr Lugano Wilson 

By Lugano Wilson

Glaucoma is becoming an increasingly important cause of blindness, as the world’s population ages. The eye disorder damages the optic nerve [carries information from the eye to the brain], not a nominal damage, an irreversible one.
This condition that can sooner or later lead to blindness needs to be taken seriously, especially when one experiences a decrease in vision ability or eye pain, a matter which is envisaged to have ripple effect across the medical practice in the country.
What compelled me to write and talk about glaucoma is from my experiences with one of the two glaucoma patients whose story needs to be highlighted to raise awareness among my readers.
Hamadi*, a college student began experiencing  sudden onset of visual disturbances, often in low light and eye pain. At times, it was associated with halos around harsh light. He always ignored them, signing it off as maybe a tiring day or stress because of college work.
When it got worse, he would head to a pharmacy and purchase eye-drops, thinking it would ease the symptoms. But nothing would help or ease.
Hamadi finally decided to seek medical help. Upon asking him why he never seeked medical attention early, he said, “I feared and worried over the possibility of being prescribed glasses.”
Unfortunately, he was diagnosed with glaucoma. A disease that damaged his optic nerve  due to increased intraocular pressure, caused by  fluid build up in front of his eyes.
Most people with glaucoma have no early symptoms  or pain.

Causes
Glaucoma is often linked to a buildup of pressure inside your eye. The fluid is called aqueous humour,  it flows out of the eye through a mesh like channel. If the channel gets blocked,  the liquid accumulates.
The reason for the blockage is unknown,  but it tends to be inherited and may not show up until later in life. Far less common causes  include a blunt or chemical injury to your eye, severe eye infections,  inflammatory conditions and blocked blood vessels. It affects both eyes but it can be worse in one eye than the other.
 Doctors do classify glaucoma into open angle glaucoma and angle closure glaucoma. Ask your doctor about the type of glaucoma you have. Dr Google won’t give you an explanation on this one selectively and lively. Open angle glaucoma is said to be most  common type. You know what happens here is that the draining structure in your eye, looks normal but fluid doesn’t flow out like it should.
But in closure angle glaucoma, your eye doesn’t drain right, because your drain space between your iris and cornea becomes too narrow, hence abrupt  build up of pressure.

Who is at risk?
It mostly affects adults over 40, but young adults,  children and even infants are at risk.
Risk factors include those who have family history of glaucoma, diabetes, poor vision, taking medications such as steroids and previous trauma to the eyes.
Most people do not have symptoms. The loss of peripheral or side vision can go unnoticed until later stage of the disease, that’s why eye doctors call it the sneak thief of vision.
In avoiding all this, Tanzanians are advised to do eye examinations at least once a year.
In cases you have sudden eye pain, headaches, blurred vision, the appearance of halos around light, redness in the eyes, eyes that look hazy,  nausea and vomiting, seek medical attention immediately.

Treatment
Your eye doctor may use prescription of eye drops, surgery to lower pressure in your eyes. The famous medication in Tanzania is ‘timolol eyedrops’, sold at Sh3500-5000 per tube in Dar es salaam.
The other one ‘zolichek’, which is said to be better than the former and is sold at a minimum  price of Sh25,000 per tube which may last for two weeks. But always consult your doctor before heading for over-the-counter drugs or self-diagnosis.
I also urge you to be careful with prescribed eye drops, some if not many are nearing the expiry dates since they are rarely prescribed. They stay longer unsold, therefore, look at the expiry date before buying.
 Glaucoma victims, don’t give up taking your medicine and be strong,  as you know the law of nature has one mantra,  “be strong .”
The author is a medical doctor, public health activist and researcher based in Dar es Salaam.

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For 14 years, she lived with painful swellings

Thursday January 24 2019



Dr Lugano Wilson

Dr Lugano Wilson 

By Lugano Wilson

For the past 14 years, Susan* lived with swelling of armpit and vulva [the external opening of vagina].
It began with a small bump on the left armpit and gradually over these years, it increased in size, got really painful and itchy. A few months later, the same appeared on the right armpit.
Susan thought it might go away. But six years later, swelling of a similar type appeared on both sides of the vulva.
The vulva swelling was very painful associated with lower abdominal pain radiating to her back. Still no medical help, a few months later, the swelling developed into ulcers, discharging a foul smell and a thick fluid that looked infectious.
Not only that, her menstrual cycle went from regular to irregular. For the past three months, she hasn’t gotten her periods.
The 29-year-old comes from Kigoma and was referred to Dar es Salaam from Bugando Medical Centre based in Mwanza where she initially sought diagnosis.
Though the physical examination was performed on her, it wasn’t very clear due to narrowing of the vagina opening due to swelling and ulcers.
I had to review her before we could take a further decision.
A battery of tests were ordered including biopsy that was taken for histological diagnosis during excision of the tumour , thus it was irresistibly concluded that the patient had a benign tumour known as ‘Angiomyofibroblastoma’. And she had to undergo a surgery.
 In pursuit of freeing herself from the bondage of sickness, the  father’s favourite daughter, Susan,  had been to  many hospitals,  prayer houses, prophetic congregations and traditional healers.
One thing that Susan kept reiterating was how her father has been her major support system. He has been with her till date through thick and thin in search for a treatment.
She said, “Baba ananipenda sana ndo maana anauza kila kitu ili nitibiwe.” [Loosely translated in english - My father’s love to me is so immense, such that he had to sell everything in a bid to facilitate my treatment].
Suffering from this for so many years, Susan had to quit college where she was pursuing nursing studies.
Angiomyofibroblastoma  of the vulva is a benign tumour of the soft tissues that occur in the vulva abbreviated as AMFB of the vulva. It’s rare tumour that mostly affects females in the age of 25-50 years.
We tried to look into the causative risk factor but our endeavours ended in vain. We searched for various literatures in the course of broadening our understanding. Our research concluded that some tumours have revealed certain genetic abnormalities.
An important reminder is that AMFB is not a sexually transmitted disease.

Symptoms
Normally this tumour grows at a very slow rate as we have seen that it took 6-14 years to manifest in Susan’s case.
It may present with no pain or tenderness but hers was painful and tender on touch.
These soft tissue tumours are well circumscribed  with very clear borders. AMFB can present as a polyp in the vulva or vagina.  They are firm and rubbery on palpation,  of course I was able to feel it in theatre after when it was cut , I can vouch for that it was solid and very firm.
It’s said that some ladies may present with a sense of pressure in the affected region when and if the tumour grows to a large size. Many of them are less than 5cm but some can grow unidentified up to 14cm especially when they are symptomless.
Large ones present with pain in pelvic region, they urinate more often and they also have  back pain.
Another important symptom is that they present with pain during sexual intercourse.

Complications
Susan’s surgery was performed but there was more to be done to evade complications.
Emotionally, Susan wasn’t stable. She was distressed and distorted completely having suffered this for the past 14 years. Hence she needed emotional support, therapy.
She had pre and post surgery infections and had to undergo post surgical wound pressure  dressing and the subsequent plastic surgery.
One thing I learnt from Susan and her father is that ‘support’ matters. No matter how bad the condition, disease is - family needs to be there for them.

The author is a medical doctor, public health activist and a researcher based in Dar es Salaam.

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Power of art in healthcare

Monday January 21 2019

 

By Jamilah Khaji & Syriacus Buguzi

It was a cool Friday morning at Morogoro Regional Hospital, last week. Dr Peter Bulugu, 32, sat quietly in the paediatric ward and watched, as nurses moved their trolleys from bed to bed—stopped at some points—as they drew out syringes to administer medicine to crying babies. Dr Bulugu had just painted pictures on the hospital’s walls . He is a doctor and a painter.

“Babies fear injections and adults, at times,’’ says Bulugu, a doctor who quit medical practice and ventured in artwork. Based in Zanzibar, Bulugu is now popular as Daktari mchoraji (a doctor who draws). Through his experience in drawings and paintings, he says he has learnt how to promote people’s health through artwork.

“Unfortunately, we grew up seeing pictures of nurses injecting crying babies. Such pictures were common on the hospital walls, doors and posters. This has had implications on how we perceive hospital settings and how we tend to seek for healthcare,’’ says Dr Bulugu.

But, last week at Morogoro Hospital ward, Bulugu says, a momentary sense of calm was palpable as some mothers whose children were crying for fear of being injected, took solace in the new artwork paintings that he was putting on the hospital walls. “The mothers used this to calm down their crying babies.”

“It was phenomenal,’’ says Dr Bulugu who, for the past few months, has been running a charity project to paint hospital walls with attractive images as a way of promoting positive behaviour among people seeking medical care.

“I had this idea of doing something for children in the hospitals. I shared it with colleagues-doctors, we agreed with each other, so I donated pictures in three hospitals; at Temeke in Dar es Salaam, Vijibweni in Kigamboni plus this project in Morogoro,” he says.

“At Morogoro Regional hospital, where I recently spent about two weeks, I saw how babies reacted inquisitively to painted walls. You see, there is a close connection between a state of mind and different colours, images or paintings,” he says.

He refers to a study in the Journal of the Royal Society of Medicine (JRSM) which concluded, “[…] visual art in hospitals can provide medical benefits to patients, but […] the quality of the evidence is not uniformly high.”

Titled: Visual art in hospitals: case studies and review of the evidence, the study however, further says, “[…] patients who are ill or stressed about their health may not always be comforted by abstract art, preferring the positive distraction and state of calm created by the blues and greens of landscape and nature scenes […].”

Artwork is increasingly becoming an important part of treatment in Tanzania due to the growing demand for friendly services for reproductive child and adolescent health, says a clinical psychologist based at Muhimbili National Hospital (MNH), Mr Isaac Lema.

“In mental health, we are also relying on artwork to diagnose certain patients,’’ he tells Your Health.

“For instance, patients who have experienced traumatic events, such as disasters, abuse or rape; at times may fail to communicate their inner feelings to psychologists. So, there is a way of making them express these feelings by asking them to draw a series of images on a paper,’’ says Mr Lema.

“This is called art therapy, and through the pictures that the patients draw, psychologists can go along to interpret or rather diagnose their problems and intervene accordingly,” says Lema.

For the case of hospital wall paintings, Lema insists that the demand for making a hospital appear friendly has been increasing due to the growing push for reproductive child and adolescent health.

“Through the use of this artwork, more and more children and adolescent can develop positive behaviour in seeking healthcare,’’ he explains during an interview with Your Health.

Dr Bulugu’s story. How he quit medicine

“I think I have real passion for painting. My mother was a nurse. Perhaps that’s why I ended up going to medical school to study to become a doctor. I loved being a medical doctor but in the long run, I realised that I had a great desire in something else,” he added.

But, he recalls, “I started painting when I was in primary school, I always painted pictures of students and teacher in class, I used to participate in different competitions in school too.”

Bulugu says he continued being engaged in drawings up to university at the Muhimbili University of Health and Allied Science(Muhas) where he graduated in 2013 and later went to Zanzibar for internship at Mnazi Mmoja Hospital.

“When I was in Zanzibar I was exposed to art. There is a large number of tourists visiting the Isles. There are a lot of tourist shops where they sell paintings, so I decided to join in my extra hours and weekends,” he recalls.

Later, when he was finally registered as a medical officer, he started working at Ikondo hospital in Makete in Njombe Region in 2015 but in early 2016, he left the job to start up a drawings and paintings shop in Zanzibar.

“I found that friends I had been working with, had gotten their own shops and they were earning a living…I was inspired and I decided to join them. I started with a small shop in May 2016 and I had to work so hard,” he says, as he details his employment journey.

He now runs two shops; one in Nungwi and another one in Stone Town, in Zanzibar.

“So, in December 2018, I decided to give back to my society. That’s how I came up with this idea of promoting health in hospitals through paintings on walls.”

“I use a lot of green and blue colours. Psychologically […] blue and green colour calm down minds, so in my drawings I tend to use these colours,” says Dr Bulugu.

“These colours promote emotional recovery, that includes relieving anxiety and decreasing perception of pain. The art can reduce stress and loneliness and provides opportunity for self-expression.”

“This can help people reduce the use of painkiller medication and length of staying in the hospital. In return, this reduces treatment cost because they stay for short period in the hospital and reduce painkiller intake. It reduces error and increase effectiveness in providing healthcare.”

“This artwork is important for medical students. It enhances their skills, improves their observational, diagnostic and emphatic abilities, it helps them to understand patients in various ways, “

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Heart health: why it matters to women

Monday January 21 2019

 

By Jamilah Khaji

We’re all aware of the importance of taking good care of our heart health, but it can be difficult to know how.

The heart is an organ responsible of circulating blood in the body. It is made up of muscles that pumps blood every time we breath.

When the heart is not well taken care of, it develops an abnormal behaviour, which results to heart diseases and failure.

Heart disease is the one that affects the heart, blood vessels and the circulatory system in general. According to mayoclinic, heart disease may often be thought of as a problem for men, heart disease is the most common cause of death for both women and men, claiming at least 17.9 million lives every year, globally. One challenge is that some heart disease symptoms in women may be different from those in men. Fortunately, women can take steps to understand their unique symptoms of heart disease and to begin to reduce their risk of heart disease.

Risk factors

Women face a higher threat of heart disease in Tanzania and most of them are not aware of the risks, says Dr Pedro Pallangyo based at the Jakaya Kikwete Cardiac Institute (JKCI), in an interview with Your Health.

Majority of the heart disease cases they have been receiving recently, involve more women than men. “Poor lifestyle marks the beginning of heart diseases,” says Dr Pallangyo.

There are many risk factors which contribute to the heart diseases for women such as genetic predisposition, smoking, excessive alcohol intake, overweight and old age.

“Women who are at a higher risk of being attacked by a heart disease, are either in their reproductive age or elderly,” he says.

Dr Pallangyo explains the risk factors in depth and how they can lead to heart disease as follows.

1. Obesity

Obesity or overweight is becoming more dangerous for women especially in reproductive age because of the many factors that goes along with pregnancy and breastfeeding.

Pregnancy and breastfeeding leads to overeating more than normal, hence the consequence of adding too much weight.

Overweight women are at a higher risk because their blood circulation is low. It also means their cholesterol level is high, which blocks the blood to circulate normally.

2. Lack of exercise

Many women do not have the habit of doing regular exercises. Exercise helps open blood vessel which circulate blood in the body, it also lowers blood pressure and keeps body fit. Eventually helps fight against diseases. It also helps lose weight and improve cholesterol level which is the main risk for the heart diseases. Exercise helps to strengthen heart muscles and become more efficienct in pumping blood better to the rest of the body.

3. Unbalanced diet

Eating a balanced diet has many advantages to the body. One of them is to build body immunity, which helps the body fight against diseases, also eating the right portion of food helps prevent body from adding weight. Balanced diet includes eating healthy foods like vegetables, fruits and other natural foods. Bad eating habits may result to excessive weight gain which cause obesity and high blood pressure.

4. Heredity

When members of a family pass traits from one generation to another through genes, that process is called heredity.

Genetic factors likely play some role in high blood pressure, heart disease, and other related conditions. However, it is also likely that people with a family history of heart disease share common environments and other potential factors that increase their risk.

The risk for heart disease can increase even more when heredity combines with unhealthy lifestyle choices, such as smoking cigarettes and eating an unhealthy diet.

5. Smoking

Women who smoke have a high risk for heart diseases than the ones who don’t smoke. To quit smoking, is the one of the safest ways to avoid heart diseases. Chemicals from tobacco affect blood vessels, it also blocks the arteries which circulate blood in the body which can result to heart diseases.

6. Pregnancy complications

High blood pressure or diabetes during pregnancy can increase a woman’s long term risk of heart diseases. Also other non-communicable diseases like diabetes can increase the development of heart diseases in mother.

7. Diabetes

Data from Heart National Association from 2012 shows that 65 per cent of people with diabetes will die from heart disease or stroke. Women with diabetes are at the highest risk of being attacked by heart disease.

Dr Pallangyo suggests that in order to avoid or minimise risk of heart disease among women, it is better to deal with all the risks that are aforementioned.

Prevention is better than cure

Dr Pallangyo suggests that little lifestyle changes can spurt to bigger and better health outcomes.

He says, “Exercise should be necessary for every individual, exercise is important to the body, it fights against diseases, it helps lose weight and makes the body active.”

He further emphasises on the right portioning of meals and balanced meals. “Eating healthy, balanced and right portion of food is essential in order to avoid obesity and all diseases that comes along. Food is good for the health but if it is not eaten well, it becomes toxic, dangerous and poisonous for the body,” he advises.

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Let’s not expect hospitals to waive bills when a patient dies

Monday January 21 2019

An inside shot of a hospital room. PHOTO |

An inside shot of a hospital room. PHOTO | PIXABAY 

By Nelly Bosire

What would our loved ones say if they could speak to us before they are interred?

“It is well my loved ones, I have found peace.”

“It was a life well lived.”

“Do not weep, I am no longer in pain.”

“It is time to release me from the indignity of sickness.”

“Oh my children, who will take care of you now?”

“Oh no, I wasn’t done with my business yet.”

The period between death and burial or cremation is one of the most controversial in the existence of the departed. As loved ones mourn, all manner of issues crop up that leave many dumbfounded.

This happens, regardless of the person’s background. People fight over where a person will be buried, how to bury them or who to take part in the burial.

Wives and children come out of the woodwork to claim recognition, and previously unknown children demand DNA samples from the dead to prove paternity. This often leads to prolonged court battles, putting the burial on hold as the matter is arbitrated. While all these incidents are going on, many families continue to grieve without closure.

The fight over the dead points to a belief harboured by many of us that their interment is final.

We do not believe that there can be continued engagement on the departed after the final ceremonial rites have been carried out. Children born out of wedlock will not be officially recognised if they are not accorded that honour during the funeral service. Families will be seen to have “lost” their kin if they do not get to bury him on family land. There is even war about who gets to keep the death certificate!

This cultural setup sets the pace for our financial engagements, spilling right back into matters of debt settlement. Institutions then hold the belief that the most valuable possession for the family of the deceased is the actual body, hence the only way to ensure debt settlement is holding on to it.

Detaining the dead

Unfortunately, the only time the dead’s kin demonstrate unity in facing the bills left behind is before the last rites.

Once these are done away with, the burden is left to the immediate family to resolve. This has paved way for the negative culture of holding onto the dead.

The culture of detaining the dead in hospital mortuaries awaiting the clearance of hospital fees is pervasive across the health sector. It doesn’t just happen in the private sector only. It happens even more commonly in public hospitals.

It is a matter that has raised concern, with some even demanding that parliament passes legislation outlawing detention of bodies. The conversations need to be much broader than dealing with the end point. Hospital bills are devastating families and impoverishing them. It is simplistic to assume that once one has passed on, it is immoral for the hospital to recover its cost of care. Hospital costs will continue to accrue irrespective of the eventual outcome.

To make matters worse, families make irrational decisions, when the health of a loved one deteriorates.

Desperate to do whatever it takes to make the person better, they fundraise to take a terminally ill cancer patient to India, even when it is clear that he will not get better.

This is the nature of mankind. The same family will call upon the same well-wishers to fundraise to bring the body of their loved one back home for burial. What we need are solid, continuous conversations around this sensitive issue.

All of us are potential healthcare debtors. Universal health coverage alone will not cure this. There is need for a mind shift. It is possible to have clear processes that allow hospitals to recover their costs without taking away dignity even in death!

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The painful truth about fibroids

Monday January 14 2019

A woman holding her stomach in pain . PHOTO |

A woman holding her stomach in pain . PHOTO | FILE 

By Nelly Bosire

Zumira* sat forlornly on her bed during the teaching ward round. She was visibly uncomfortable and wished she could be somewhere else.

Twelve years before, she had been in this very ward at the national teaching and referral hospital.

She was 26, young and full of hope. She had completed college and her first job was coming along quite nicely. She had even moved out of home and was excited about living independently.

However, her period was getting heavier each month, and though she had always suffered cramps during menses, the pain was becoming excruciating, needing constant medication.

However, she was too busy living to make time to see a doctor until her mother intervened and forced her to seek care.

A physical examination revealed that she was pale, with a mass in her lower abdomen that was the size of a 16-week-old pregnancy.

The fibroid diagnosis was confirmed by ultrasound and she successfully underwent surgery to remove them. Following surgery, she did well, optimistic that the worst was over.

At her post-operative review, she was seen by a senior professor. The jolly old Prof teased her, but told her that the fibroids would recur with time, so she seriously needed to think about having children before this happened.

Once discharged, Zumira resumed her fast-paced life. The pain faded, the periods became lighter and the good old professor’s wise counsel was ignored.

Bad weed

Ten years flew by and before she knew it, the familiar old symptoms crept back like a bad weed.

One day, after a particularly rough night, Zumira knew she had to retrace her steps back to the gynaecology clinic.

She told the doctor that she was sure her fibroids were back. She could feel the uneven masses in her abdomen, two distinct mounds dwelling in her uterus. She even jokingly referred to them as visitors that had overstayed their welcome.

Things were not rosy this time round. Her fibroids were really big, the size of a 34-week pregnancy. Though the symptoms were less obvious than the last time, the prognosis was less optimistic.

The doctor was terribly unhappy to note that in the last 12 years since she had been in hospital, Zumira was still childless yet she harboured a deep desire to be a mother. After tests, she was admitted for surgery.

In the ward, she met the professor who had advised her to have her babies early. He asked Zumira what she had done with the past 12 years to fulfill her maternal desire.

We, the young doctors shadowing the professor to learn the art and science of gynaecology, were taken aback by the professor’s forthrightness. We had no idea about the discussion doctor and patient had had in the past.

Zumira had extremely tough choices to make. Here she was, in a public hospital, with limited finances and hence limited treatment options. She was scheduled for a surgery where she was going to lose her womb at barely 38 years of age.

Her dream of becoming a mother was rapidly vanishing. She blamed herself for her predicament.

She felt that she had set the bar too high for the potential father of her children and while she waited around for the right one to come along, unwelcome visitors had silently crept into her womb and robbed her of an opportunity to be a mother.

Right there and then, she wished more than ever, she could be anywhere in the world other than in a hospital bed surrounded by a bunch of strangers feeling sorry for her.

Commonest tumours

Fibroids are the commonest tumours that occur in the reproductive system of women. They are three times more common in black women than white women.

They are abnormal growths in the wall of the uterus that may occur singly or in multiples, but they are not cancerous.

They occur during reproductive age and thrive on oestrogen, tending to shrink after menopause as hormone levels decline. They may cause heavy, painful menses; a dragging sensation in the pelvis; obstructive symptoms such as constipation and incomplete emptying of the bladder that results in recurrent urinary tract infections; and infertility.

Treatment options are tailored to the patient’s desires, age, number of children, symptoms and present complications.

These include no treatment especially if the fibroids are small and asymptomatic; surgery to remove the fibroids (myomectomy) or removal of the uterus (hysterectomy).

Medication to cause a temporary state of menopause to shrink them and uterine artery embolisation which cuts off blood supply to individual fibroids, causing them to die off and shrink, are other treatment options.

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Balanced diet key for school going children

Monday January 14 2019

 

By Your Health Reporter

Mental processes related to knowledge, attention and reasoning as well as brain development and formation in children, are often determined by the nature of a child’s diet.

Neglecting a child’s nutrition both at home and at school could lead to serious complications such as poor vision, obesity, and delayed brain reaction, affecting the child’s listening and retention abilities, which are important for good academic performance.

Schools are often encouraged to give their pupils a balanced diet (carbohydrates, proteins, minerals and vitamins in the right proportions needed by each individual).

A balanced diet is a meal consisting of the proper quantities and proportions of foods needed to maintain good health or growth.

“Your brain requires sufficient nutrients to function normally. Proper nutrition is essential for normal cognition and thinking skills.

A healthy diet that is low in fat and high in essential nutrients reduces the risk of memory loss, helps prevent strokes and boosts alertness,” says Dr Lynnth Turyagyenda, nutritionist and public health specialist at Mwanamugimu Mulago hospital.

Nutritionists advise eating at least three meals a day. Since children play a lot and use the brain excessively when studying, the meals taken are used up rapidly hence getting hungry quickly.

Turyagyenda further explains that a brain needs a steady supply of glucose or sugar to concentrate and stay alert. Carbohydrates are the best source of this fuel.

Certain dietary minerals including magnesium, manganese and iron are needed for the body to break down glucose.

Most schools consider ugali and beans a favourable meal for their pupils, notwithstanding the fact that this kind of meal is not a balanced diet.

What makes it worse is that pupils are given small quantities of food only for them to be hungry within a short time.

A mixture of iron from animal and plant food in the students’ meals is highly recommended for its effectivework toward brain functioning.

“A deficiency in iron also prevents adequate oxygen delivery to the brain which can cause fatigue and poor mental performance.

Iron is found in animal and plant foods, but the type of iron in animal foods is best utilised by the body. Top sources of this type of iron are chicken, beef, liver, oysters and dark-meat turkey,” Turyagyenda further advises.

Example; foods that are rich in iron are spinach, legumes, red meat, pumpkin seeds and broccoli.

Research findings

Tanzania still has a large proportion of children who are malnourished.

For instance poor nutrition is serious challenge in Njombe, a town in southern Tanzania, where 49.4 per cent of under-fives are stunted.

That is the situation despite Njombe being one of major producers of food crops in Tanzania.

These high prevalence levels of malnutrition have a negative impact on the general survival, growth and development of children under five and slow down progress towards attaining the Sustainable Development Goals and the overall national development.

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Cervical cancer can be prevented, treated

Monday January 14 2019

A safe and effective HPV vaccine pro-vided to a

A safe and effective HPV vaccine pro-vided to a young girl (between 9 and 14 years old), to protect her against HPV and therefore cervical cancer. PHOTO | FILE 

By Jamilah Khaji

Last year in April, Tanzania achieved a historical milestone to roll out a Human Papilloma Virus (HPV) vaccine against cancer of the cervix, the second most common cancer in women worldwide. It was very encouraging to learn that the government had taken such an important step.

According to data from World Health Organisation (WHO), the East African region is the leading burden carrier of cervical cancer. Tanzania is among the five countries with the highest rates in Africa.

Medical experts explain that cervical cancer is the type of cancer that occurs and initially grows in the cells of the cervix [the lower part of the uterus]. It is caused by Human Papilllomavirus (HPV), which is the common viral infection of the reproductive tract and almost all sexually active women can be infected by HPV at some point in their lives.

WHO further records 570,000 new cases of cervical cancer in 2018, globally, representing 6.6 per cent of all female cancers. Approximately 90 per cent of deaths from cervical cancer occurred in low- and middle-income countries.

The good news

Unlike other cancers, cervical cancer is 100 per cent preventable through a comprehensive approach of effective screening programmes. The society needs to be made aware of regular check-ups and symptoms to be detected at its earliest stages.

Dr Heri Tungaraza, an oncologist based in Dar es Salaam, tells Your Health that it is advisable for girls at 14 years to receive (HPV) vaccination which helps prevent infection from virus causing cancer. “This vaccination prevents abnormal cells from developing into cancer,” he says.

Risk factors

According to International Journal of Chronic Diseases, in East Africa, the age standardised incidence rate (ASR) is estimate at 42.7 new cases per 100,000 women. Tanzania ranks second in the region with 54.9 out of 100,000 women.

Each year, more than 7300 women are diagnosed with cervical cancer in Tanzania and more than half of these women die because they are diagnosed in the late stage of the disease.

“Having multiple partners or sexual activities in early age for girls is one of the biggest risk factors, which may lead to development of cervical cancer. It takes more than 30 years for a woman to develop this cancer,” says Dr Tungaraza.

He adds that groups of women who are at risk more are the ones who smoke cigarettes. It is known that the substances from the tobacco damages DNA of cervix cells and may lead to development of cervical cancer.

Having a family history of cervical cancer put women at a high risk of developing the disease.

Overweight is another risk factor of cervical cancer. “It is better for women to control their weight because it puts them at a high risk of developing this disease. We advise all women to eat a balanced diet that includes a lot of vegetables and fruits as well as daily exercises,” advises Dr Tungaraza.

Other risk factors include HPV infections and HIV infection. Dr Tungaraza explains, “Group of women who are HIV positive have low immunity, hence the chance of cervical cancer attacking them is higher.”

Symptoms

Dr Tungaraza says that women need to be aware of the symptoms and their body for early detection. These are:

• Abnormal vaginal bleeding. This can be in between menstruation or after sex.

• Pelvic, back and leg pain. Pelvic pain is an indicator of changes in the cervix, sometimes. It has the ability to spread in the intestine, lungs and liver which can cause swelling.

• Discharge from vagina which may have a foul smell and can be brownish, bloody in colour.

• Body weakness because it has the tendency of lowering the production of red blood cells and oxygen in the body, which causes the patient to feel exhausted all the time.

In order to prevent cervical cancer women should have the habit to go for regular check ups, especially those who are between 30-65 years.

Some of the recommended tests are pap smear and visual inspection with acetic acid. Talk to your doctor if any signs and symptoms persist.

hajijamillah@gmail.com

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Rubella and pregnancy: What you need to know

Monday January 14 2019

 

By BEATRICE NAKIBUUKA

Blair Atuhomugisha is three and a half years old. His mother Linda Byabazaire suffered from German measles (rubella) when she was three weeks pregnant.

She developed a rash on her hands and the lymph nodes at the back of her ears were swollen. When she asked her mother what the problem could be, she advised her to go to hospital in order to get proper diagnosis.

“I went to several hospitals and although the doctors carried out several tests, they failed to pinpoint the exact problem. They said I had a virus but weren’t sure which one. Therefore, I could not receive any treatment though the symptoms disappeared two weeks later,” she says.

Byabazaire continued with her pregnancy and everything was normal until when she gave birth. “My child weighed only 1.9kg. This was way lower than my first born’s but it did not scare me because I knew with time he would gain weight,” she says adding: “I was, however, worried about his eyes that kept closed after birth.

Two weeks later, I realised he had cataract so I took him to Georgina Eye clinic in Bugolobi, Kampala, where the doctor recommended an immediate operation.

At two weeks, Blair was too young to undergo the operation to remove the cataract so the doctor recommended waiting until he was five weeks old. Within these days of waiting, Byabazaire noticed several other abnormalities on her son.

“He was not gaining weight like other children and whenever he would sleep, it was hard for him to get out of his sleep even when the environment was so loud. He would not respond to sound,” she recalls.

Diagnosis

During one of her several hospital visits for consultation and inquiries on what to do, Linda met Dr Charles Karamagi, a general practitioner at Family Doctors Clinic in Ntinda, Kampala. “He inquired about the conditions I suffered when pregnant and after several tests, he said Blair was suffering from rubella syndrome and recommended that I take him to Mulago Hospital to check the condition of his heart,” Byabazaire says.

At four weeks, he was diagnosed with a mild PDA; an opening on the heart which the doctor said would close with time. With this, the doctor had said he was fit for the cataract surgery that was done a week later.

“As he grew older, we realised that he is not only unable to see in the eye that was operated on but also his response to sound did not develop. While at home, we communicate using signs or touching him. Since I have now known his behavioural pattern, I know when he is angry, hungry or tired,” she remarks.

Effects

He was taken to Kampala Audiological Centre where the doctor performed hearing tests and an MRI scan which revealed that he was profoundly deaf because his cochlea did not develop well.

“He has association problems since he cannot talk or hear. He keeps to himself. He is very aggressive when he needs something since he cannot express himself. It is very painful because we cannot help him,” his mother says. She adds: “The doctors recommended that he gets cochlea implants as soon as possible to enable him hear and be able to communicate and play with other children.

This would cost about Shs120m which we do not have and need support from well-wishers.

About the disease

Rubella, also called German measles is a contagious viral infection that can be spread to another person when an infected person coughs or sneezes.

It can also spread by direct contact with an infected person’s respiratory secretions, such as mucus. Dr Anna Akullo, the immunization programme coordinator at Uganda Peadiatrics Association, says it can also be transmitted from pregnant women to their unborn children through the bloodstream.

The disease affects both children and adults but it is more severe in adults and causes detrimental complications to a pregnant mother.

Congenital Rubella Syndrome (CRS) is a condition that occurs to a developing baby in the womb whose mother is infected with the rubella virus.

When a pregnant woman contracts rubella, she is at risk of getting a miscarriage or stillbirth and her unborn baby is at risk of developing severe birth defects with devastating, lifelong consequences.

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Typhoid test to worry about

Monday January 14 2019

A medical officer holding a positive typhoid

A medical officer holding a positive typhoid test. Photo|Internet. 

By Syriacus Buguzi
More by this Author

If you have been diagnosed with typhoid fever and then subjected to treatment with common antibiotics, yet your illness doesn’t show signs of improvement, you must—among other things—ask yourself this key question today: Was an accurate test done to prove if really I have typhoid?

Most health facilities in Tanzania and other developing countries still rely on Widal test to diagnose typhoid fever, but scientists are questioning its reliability.

It is suggested that if you have high fever and abdominal pain, then, your doctor suggests a Widal test—and it turns out positive—there is still room for doubt, if your medic relied on a mere rapid test to confirm the typhoid. Most times, you need an additional test to be pretty sure of what you are suffering from.

“Unfortunately, in some developing countries […] Widal test appears to be the only laboratory means for diagnosing typhoid fever among suspected patients,’’ says a research review titled: Widal agglutination test − 100 years later: still plagued by controversy, published in in the British Medical Journal (BMJ).

Dr Elisha Osati, a medical specialist at Muhimbili National Hospital(MNH), says, “At times people end up requesting for antibiotics from their doctors simply because a Widal test turned out positive when they went for the test, but only to realise later that the antibiotics weren’t necessary.”

“There must be enough reasons first; to conclude that the patient actually has typhoid,’’ emphasises Dr Osati.

“Widal test is not conclusive. To confirm the disease, a medic has to go the extra mile. What we call titration has to be done. One other step is to do a culture and sensitivity test. But there are many health facilities that are still unable to perform the culture and sensitivity test. This is where problems begin,’’ he points out.

“My advice to patients is that they should always talk to their doctors and be sure of how they are being diagnosed with typhoid. They shouldn’t simply ask for or accept antibiotics. Inappropriate use of antibiotics fuels antibiotic resistance,’’ cautions Dr Osati.

“We strongly advise that such facilities refer patients to where this test can be done. Do they refer? That’s something to question now,’’ insists Osati, who is the president of the Medical Association of Tanzania (MAT).

The government has since issued a circular No:HC.49/421/01/52, indicating that Widal test is not done appropriately at health facilities across the country but the practice has not changed for the better—even in recent years.

You have NHIF card? Choose wisely

The National Health Insurance Fund (NHIF) covers Widal test as part of your treatment package, but on condition. Your health facility must not lie.

“We [at NHIF] are bound to engage with facilities that follow standards of practice. If we assure ourselves that a certain health facility does not diagnose typhoid correctly as dictated by treatment guidelines, we are keen not to engage with it,’’ says Dr Edwin Chitage, a Quality Assurance Officer at NHIF.

The Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) says it will not tolerate health facilities with diagnostic laboratories that can’t use the Widal test correctly.

Ms Neema Haliye, the ministry’s Acting Registrar of Private Health Laboratories Board (PHLB) says health facilities must ensure that when a Widal test is done in their labs, and it turns positive, they should carry out further tests to confirm.

“[…]We are receiving complaints from NHIF that some health facilities submit claims for Widal tests that are questionable,’’ says Ms Haliye, who is also a medical laboratory scientist at the MoHCDGEC. “Usually, a health facility that meets the standards of offering this test has to submit an application to us, and we give it authorisation, but we haven’t actually gone on the ground in all health facilities to trace if they are following the procedures correctly or not,’’ she admits.

How common is typhoid in Tanzania?

Typhoid fever, a life-threatening infection caused by a bacterium known as Salmonella Typhi, is a common problem in Tanzania, studies show and doctors say most people are aware of the disease but not necessarily-knowing how to prevent it.

“Almost all patients who visit hospitals[…] at least know the word “typhoid” to the extent that a patient may not even narrate his/her history[of illness] to the doctor instead he/she will ask to be tested for it[typhoid],’’ says Dr Wilson Lugano, a medical officer who has practiced at various medical facilities in the country.

Globally, the World Health Organisation (WHO) says that every year, an estimated 11–20 million people suffer from the disease and between 128,000 and 161,000 people die from it.

Confused with other illnesses

Typhoid, according to medical experts, has become challenging to detect in patients because its symptoms resemble those of other diseases such as malaria, which also cause fever.

The Widal test, widely used labs at health facilities, has played a major role in the diagnosis of typhoid fever but recent research reveals there are several pitfalls in how it is used and how results are interpreted.

People must begin questioning

In recent months, the Deputy Minister of Health Community Development, Gender, Elderly and Children, Dr Faustine Ndugulile has warned the public against the tendency of medics at health facilities “unnecessarily” diagnosing patients with typhoid.

“Quite often, we witness cases of patients at our health facilities being told they are suffering from typhoid without sufficient evidence to prove the diagnosis,’’ said Dr Ndugulile on July 10, 2018 during an interview on eatv.tv.

“It is high time patients begin questioning whenever they are given results of their typhoid tests in half an hour at certain health facilities […] mostly, in ideal practice, the results must be out after 48 hours,’’ said Dr Ndugulile, who is also a specialist in public health.

six.buguzi@gmail.com

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Sexual health: The proper way to delay your period

Monday January 7 2019

 

By Joachim Osur

Jared walked into the consultation room with his wife, Alice, and declared that they had an acute emergency. However, my trained medical eyes and my sixth sense could not immediately identify the said emergency. Neither of them showed any sign that breathing was about to stop or that the heart would cease in a short while.

“I am serious,” Jared said when I prodded more. “Culture dictates that we must have sex tomorrow night yet she just started her period this morning!” Jared continued. “Do what you can to immediately stop those periods or this is going to be catastrophic.”

Culture

Jared was a 48-year-old farmer. Alice was 45 and a business lady selling second hand clothes in the local market. They had been married for 23 years and had five children. According to Jared, they were to start building a new rural home the next day. He had mobilised resources including labourers, building materials and a caterer to make food for the occasion.

“So in my culture you have to build a small hut on the day the home starts and spend the night in the hut,” he explained. “That first night is very important for making the home safe for me and my children.”

The safety of the home, according to Jared, was pegged on the owners having sex. It is ritual that cleanses any future evils and if not performed, the couple or any of their children could die. It was however culturally illegal to have such sex when a woman is on her period.

“Wow that is a real uphill task for me, she is already having her periods you said?” I asked, not sure how to help.

Medically it is better to have nature take its course and let periods flow when they come. There are however a few occasions when a doctor may prescribe medicine to delay or postpone the period. If a couple is in a long distance relationship, they may have only one or two nights to be together. We frequently find women in such relationships seeking to delay their period so as to be intimate with their long distance man.

Delay, postpone or stop periods?

Another common occasion is when a couple is at wedding. Wedding dates are fixed many months in advance. As the date approaches, a lady may notice that she will be in her periods on the wedding day. This would definitely not augur well, especially for those couples who abstain until their wedding night. Such couples come to the clinic desperately seeking to delay the period.

Celebration times such as Christmas and New Year holidays also present people with this challenge.

“It is good to know that I am not the first one to request this,” Jared interrupted, a smile pasted on his face.

There is however a difference between delaying or postponing periods and stopping periods. If you intend to delay or postpone your period, you must take the medication at least three days before the expected day of start. Once the period has started, there is little one can do to stop it.

“But her periods are irregular, how did you expect me to predict them?” Jared was getting irritated. Alice had been quiet all along. She suddenly went into a fit of emotions and started crying uncontrollably.

“You do not understand, if the periods do not stop we cannot proceed with these plans yet everyone in the village is excited and waiting for us tomorrow morning!” Jared said.

“And my children will die if things are not done the right way in starting the new home, I cannot afford to lose my children!” Alice said amid sobs.

After exploring all options, Jared and Alice opted to have Alice admitted in hospital to fool the village into thinking she was too sick to travel. Three days later Alice was discharged. Her period had ended. They travelled the next day to go and start their new home. It was another experience of how culture and sexuality interact.

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Major medical milestones, pitfalls that painted the year 2018

Monday January 7 2019



Conjoined twins before surgery. Photo|File

Conjoined twins before surgery. Photo|File 

By Jamilah Khaji

Tanzania became the first country in Africa to achieve a well-functioning regulatory system for medical products—that was in 2018—a year that saw the country make giant leaps in health sector development, albeit clouded with pitfalls that arose from the government’s new decisions.

The year 2018 ended on a high note though, as—on December 10—the World Health Organisation (WHO) announced that the Tanzania Food and Drug Authority (TFDA) had made significant improvement in insuring medicine used in the country’s health sector is safe, good quality and is produced in a clean environment.

Fewer than 30 per cent of the world’s medicines regulatory authorities are considered to have the capacity to perform the functions required to ensure medicines, vaccines and other health products actually work and do not harm patients, WHO said.

WHO facilitated and conducted self-assessment of and formal evolution of the TFDA and Zanzibar Food and Drug Authority to make some adjustment, so TFDA met all indicators that meet maturity level 3, of the WHO’s scale and target for regulatory system globally.

Not an easy ride for health sector

The WHO achievement added to a list of key developments that highlighted the successes of Tanzania’s health sector last year however, it wasn’t short of gaps and dilemmas.

On September 10, family planning programs—some of the country’s key health sector key projects—largely funded by donors—were in tight spot following a surprise stance expressed by President John Magufuli on family planning.

On his tour of the Lake Zone last year, President Magufuli chided those who embraced family planning, terming them “lazy.” His remarks sparked debate on whether family planning programmes in the country would continue or not.

Speaking in the presence of the United Nations Population Fund (UNFPA) representative in Tanzania Jacqueline Mahon and health minister Ummy Mwalimu, the president said those who use contraception do not want to work hard and trying to avoid the responsibility of feeding their children.

There was no indication that President Magufuli’s opposition to birth control would lead to change in policy, however, since he made remarks, little has been popularised about family planning in the country, evidence being on how the 2018 World Contraception Day passed without a major highlight in Tanzania; as it had been the routine before.

Tanzania successfully separates the conjoined twins

Nonetheless, on September 22, 2018, the country’s major referral hospital—the Muhimbili National Hospital (MNH)—made history in following a successful separation of conjoined twins, a surgical procedure that was done locally through collaboration between foreign and local surgeons. A similar achievement had been recorded, 24 years ago.

The twins—from Kisarawe District, coast region, were separated by a team of 10 medical specialists from Tanzania and one from Ireland. Dr Petronilla Ngiloi, one of the surgeons on the team, said the successfully operation was a milestone in the medical operation in Tanzania.

Dr Ngiloi said the operation was successful due to the availability of modern medical investigation facilities such as magnetic Resonance Imaging (MRI) and computerised Tomography (CT) scan and ultra sound machine which enabled them to examine appropriately the internal organs of the twins.

Tanzania’s technology hits headlines

In mid last year, Tanzanians made headlines for deploying their IT innovation—a surveillance mechanism for epidemic diseases—which was introduced by experts from SokoineUniversity of Agriculture(SUA) and used in Ebola-hit regions of the Democratic Republic of Congo (DRC).

Tanzania IT scientists Mr Eric Beda and his colleague Renfrid Ngolongolo and Calvin Sindato an Epidemiologist travelled to Congo to train Trainers on how to use digital tools “Afya data” for Ebola control and research.

The digital App, Afya data was developed by researchers SUA in collaboration with IT expert to improve efficiency in surveillance of diseases and it is available to download on Google play store.

The digital app funded by US based organisation, Ending Pandemics, works by enabling people trained as community health workers who collect details on signs and symptoms on suspected disease in communities enter the information through app and send it to a server where it is stored, synthesised and analysed by experts.

Cochlear implants

MNH experts carried out cochlea implant surgery on 21 children in the year 2018. For the first time, the experts did it alone, without the assistance of foreign experts, signaling that the country was now picking up in terms of boosting the capacity of its experts.

Cochlear implant is a surgically implanted hearing electronic device that provide a sense of sound to a person who is partially or completely deaf. Not many were able to access and afford the treatment in the previous years, until MNH started carrying out the interventions.

At a cost of Sh 80-100million per surgery, per child, Tanzania stands out to be a country that may have carried out the cochlea implant surgeries at lower cost.

In Kenya, details show the services is offered in private hospitals at $31,000 per child which is equivalent to Sh70 million. In Tanzania only Sh777 million has been used for 21 children which is equal to Sh37 million per child.

Kidney transplant

The year 2018 was when the first Tanzanian underwent kidney transplant surgery at a local hospital, Prisca Mwingira, marked one year after undergoing the procedure.

The national hospital has already recorded successful kidney transplant on 19 patients since then. Ms Mwingira underwent the surgery in 2017 and she opened up to Your Health last year on what could have led to her kidney failure.

She confided on how, as a teenager, she consumed a lot of pain killers but what she didn’t know was, the painkiller were gradually affecting her kidney until the symptoms appeared and she decided to consult a doctor.

Not a rosy year for MUHAS in 2018

The Muhimbili University of Health and Allied Sciences (Muhas) lost its Mloganzila dream. Like most top-notch medical schools in the world, Muhas was now set for another big development—running its own teaching hospital. But, that dream vanished into thin air.

This follows the news that the university’s Academic Medical Centre, Mloganzila (MAMC) had been placed under the control and management of Muhimbili National Hospital (MNH), contrary to an earlier plan where, Muhas was going to lead the project.

On the hospital’s side (at MNH) authorities said they would come up with a detailed plan on how to run the new state-of-the art facility, built at Sh206 billion cost, largely a soft loan from South Korea.

“…It seems there were some challenges which affected the provision of services at the facility [Mloganzila], but since our national hospital [MNH] is experienced in the field, it will provide the anticipated quality services,’’ said MNH’s Head of Public Communication and Customer Care Unit, Mr Aminiel Algaesha.

hajijamillah@gmail.com

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For 14 years, she lived with painful swellings

Monday January 7 2019



Dr Lugano Wilson

Dr Lugano Wilson 

For the past 14 years, Susan* lived with swelling of armpit and vulva [the external opening of vagina].

It began with a small bump on the left armpit and gradually over these years, it increased in size, got really painful and itchy. A few months later, the same appeared on the right armpit.

Susan thought it might go away. But six years later, swelling of a similar type appeared on both sides of the vulva.

The vulva swelling was very painful associated with lower abdominal pain radiating to her back. Still no medical help, a few months later, the swelling developed into ulcers, discharging a foul smell and a thick fluid that looked infectious.

Not only that, her menstrual cycle went from regular to irregular. For the past three months, she hasn’t gotten her periods.

The 29-year-old comes from Kigoma and was referred to Dar es Salaam from Bugando Medical Centre based in Mwanza where she initially sought diagnosis.

Though the physical examination was performed on her, it wasn’t very clear due to narrowing of the vagina opening due to swelling and ulcers.

I had to review her before we could take a further decision.

A battery of tests were ordered including biopsy that was taken for histological diagnosis during excision of the tumour , thus it was irresistibly concluded that the patient had a benign tumour known as ‘Angiomyofibroblastoma’. And she had to undergo a surgery.

In pursuit of freeing herself from the bondage of sickness, the father’s favourite daughter, Susan, had been to many hospitals, prayer houses, prophetic congregations and traditional healers.

One thing that Susan kept reiterating was how her father has been her major support system. He has been with her till date through thick and thin in search for a treatment.

She said, “Baba ananipenda sana ndo maana anauza kila kitu ili nitibiwe.” [Loosely translated in english - My father’s love to me is so immense, such that he had to sell everything in a bid to facilitate my treatment].

Suffering from this for so many years, Susan had to quit college where she was pursuing nursing studies.

Angiomyofibroblastoma of the vulva is a benign tumour of the soft tissues that occur in the vulva abbreviated as AMFB of the vulva. It’s rare tumour that mostly affects females in the age of 25-50 years.

We tried to look into the causative risk factor but our endeavours ended in vain. We searched for various literatures in the course of broadening our understanding. Our research concluded that some tumours have revealed certain genetic abnormalities.

An important reminder is that AMFB is not a sexually transmitted disease.

Symptoms

Normally this tumour grows at a very slow rate as we have seen that it took 6-14 years to manifest in Susan’s case.

It may present with no pain or tenderness but hers was painful and tender on touch.

These soft tissue tumours are well circumscribed with very clear borders. AMFB can present as a polyp in the vulva or vagina. They are firm and rubbery on palpation, of course I was able to feel it in theatre after when it was cut , I can vouch for that it was solid and very firm.

It’s said that some ladies may present with a sense of pressure in the affected region when and if the tumour grows to a large size. Many of them are less than 5cm but some can grow unidentified up to 14cm especially when they are symptomless.

Large ones present with pain in pelvic region, they urinate more often and they also have back pain.

Another important symptom is that they present with pain during sexual intercourse.

Complications

Susan’s surgery was performed but there was more to be done to evade complications.

Emotionally, Susan wasn’t stable. She was distressed and distorted completely having suffered this for the past 14 years. Hence she needed emotional support, therapy.

She had pre and post surgery infections and had to undergo post surgical wound pressure dressing and the subsequent plastic surgery.

One thing I learnt from Susan and her father is that ‘support’ matters. No matter how bad the condition, disease is - family needs to be there for them.

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Breastfeeding: how we can break through barriers

Monday December 24 2018

 

By Janet Otieno-Prosper, @JanetOtieno ajotieno@tz.nationmedia.com

My fixer and I arrived to meet our focus group whose members are already seated in blue plastic chairs in front of a local shebeen in front of dilapidated houses. This is Mukuyuni Ward in Nyamagana District of Mwanza City.

As we started our discussion on breastfeeding, some of the participants gave their accounts of why they weaned their babies too soon.

“I thought the breast milk was not enough, and I also had to go out to look for food for my other remaining children,” one participant said.

Globally, only 4 out of 10 women are able to begin breastfeeding within an hour of birth and practice exclusive breastfeeding up to six months.

And in Tanzania, Unicef reported in May that 700,000 children are not breastfed every year, as women fear their breasts will sag. It went further to point out that in 2014, 85,000 child deaths were linked to lack of breastfeeding-related complications. Inadequate breastfeeding undermines health and development of newborn, infant and young children, according to the World Breastfeeding Trends initiative.

Breastfeeding provides major benefits not only to babies, but to women’s health, and these various favourable effects eventually increase national productivity and economic growth.

In the focus groups in Mwanza and Dar es Salaam, women cited several reasons why they are not able to breastfeed as much as they should. Obstacles include short maternity leaves, the need to work in jobs, disapproval of breastfeeding in public places, fear of sagging breasts, lack of food, poor knowledge, various myths, health challenges, and poor socio-professional support.

Disapproval women get while breastfeeding in public

Tabasum Manji Ladha, mother to a 10-month old baby, is the head of Department at Regency Medical Centre in Dar es Salaam. Since she is an expert in nursing, midwifery, critical care and trauma, she answered as an expert on such issues raised during the interview.

“As a health professional, I would like to educate mothers who are very new to exclusive breastfeeding and are confused on how to go about it. I can testify that I had a tough time breastfeeding my child in public places,” she said. “Some people used to give weird stares that made me uncomfortable.”

“But with my husband and his family’s support, I managed it well. They encouraged me to keep going. They used to tell me, maybe you will inspire someone else to breastfeed in public,” she proudly stated adding that this was relatively easy for Muslim women like her since they cover their heads.

Short maternity leave and work

The participants in Dar es Salaam focus group discussion pointed out that the legal requirement for maternity leave – 84 days – is not enough for a woman to achieve optimal breastfeeding and have enough rest before resuming work.

Dr Miriam Noorani a paediatrician at Agakhan University Hospital, says milk production declines if a mother does not breastfeed enough. She encourages mothers to express milk even at work to stimulate milk production. She encourages women who do not have place for storage to carry cooler bags to work if possible.

Leah Linti, Deputy Medical Officer at Sekou Toure Provincial Referral Hospital, called on employers and the community to support breastfeeding mothers. Other participants said some employers do not abide by labour law, which permits women to take a total of two hours for breastfeeding breaks daily; they called on Health Minister Ummy Mwalimu and her Labour counterpart, Jenista Mhagama, to discuss this issue and come up with a more favourable policy for nursing mothers. They also called on the Minister of Health Ummy Mwalimu to lobby parliament to extend maternity leave.

Lack of breastfeeding rooms

Dr Richard Rumanyika, the chief gynaecologist at Bugando Hospital, a top referral health facility in the Lake Zone, called on the government to be more strict since mothers have difficulty breastfeeding because unfavourable conditions are unfavorable for pumping milk at work. This can cause their milk supply to run dry.

Jane Msagati, a programme coordinator and nutritionist at Partnership for Nutrition in Tanzania (Panita), urged employers to set up breastfeeding stations for working mothers as it is done in the Kenya.

Myths and culture

Many women don’t know they should breast-feed their babies exclusively until they are six months old. Some believe that children should be weaned by three months. “Mothers often get told off that ‘During our time, there was nothing like six months exclusive breast feeding, but you all turned out to be just as fine and healthy,’” one participant in Mwanza stated.

Denish Kashaija the Mwanza Regional Community-Based Health Coordinator, said proper public education would solve this challenge by fostering positive social attitudes toward breastfeeding and reinforcing a breastfeeding culture.

Gaps in skills and knowledge

Dr Elisha Osati, President of the Medical Association of Tanzania (MAT) and Internal Medicine physician at Muhimbili National Hospital, recommends scaling up awareness programmes, especially on the right way to express, store and handle breast milk.

“As health practitioners, we have a big role to play in giving mothers the right information,” Dr Osati stated, adding that comprehensive post-natal care would go a long way in reinforcing breastfeeding. Dr Rumanyika said, We must disseminate accurate information on the value of breastfeeding as a powerful intervention for health and development, benefitting both children and women.”

Entertainment and media industry

The media should emphasise the importance of breastfeeding and create awareness, according to Mwanza Regional Medical Officer Dr Thomas Rutachunzibwa, who adds: “The media should not only concentrate on breastfeeding week alone. We have so many activities around breastfeeding and child health so journalists should always follow up beyond events coverage to ensure they disseminate this information all the time.”

Lack of food/poverty

Ms Msagati roots for eating of inexpensive, locally available foods, as part of ensuring women to have balanced diets. She also calls for nutritional support at the family level to ensure nursing mothers get enough food. In most government hospitals, most women are taught to start saving and storing food during ante-natal visits so that by the time their babies arrive, they have enough food.

Formula industry

The good news is that formula industry influence on this practice seems to be low, as Tanzania adopted the WHO International Code of Marketing of Breast-milk Substitutes in 1994 in its National Regulations for Marketing of Breast-milk Substitutes and Designated Product. The regulations prohibit the promotion of infant formula, follow-up formula, growing-up milks and “any product marketed, or otherwise represented or commonly used for feeding of infants.”

Public transport challenges

In Dar es Salaam, the participants pointed out that rapid transportation buses (Mwendo kasi) have seats for nursing mothers. In Mwanza, daladalas give priority to pregnant women and nursing mothers. Perhaps Dar es Salaam daladalas can learn something and follow suit to ensure women are comfortable and can to breastfeed even during transit.

Lack of breast milk bank/donations

Janet Msagati, a nutritionist and programme coordinator at Partnership for Nutrition in Tanzania (Panita), suggests that Tanzania could also borrow a leaf from other countries that are establishing breast milk banks to ensure all children are breastfed adequately.

Health challenges

Dr Shafiq Mohammed, the Director of Msasani Peninsula Hospital says some mothers may suffer from sore nipples for first few days of breastfeeding. He says women should never hesitate to consult healthcare providers immediately as such discomfort could be a sign of incorrect latching or something more serious. He says mothers at his health facility are taught how to breastfeed and prepare their nipples for breastfeeding during ante-natal care visits.

Sagging breasts

Dr Rumanyika said, “It is not true that breastfeeding makes breast sag, it actually makes breast more turgid so it should be explained better to young women why they should breastfeed,” adding that breasts sag with age whether one breastfeeds or not. He cautions that breasts should not be considered sexual symbols but as baby food. He decries that care of mother and baby is compartmentalised in most healthcare facilities so care from gynaecologists is disjointed from care provided by pediatricians.

Family and community support

Joy T Mnzava who is part of a breastfeeding support group in Mabibo, Dar es salaam, said support groups play a big role in breastfeeding. They give mothers a chance to discuss their challenges and find help. She said support should start at the family level to ensure women breastfeed and receive whatever help they need.

Government’s role

Dr Rutachunzibwa said the Minister of Health has signed an agreement with all regional officers across the country to fight the problem of stunting. The first step is a campaign to promote breastfeeding for children until they turn two. He said he is optimistic the campaign will increase breastfeeding rates.

Cessy Mrema, Mwanza Regional Reproductive and Child Health Coordinator says so far they have been educating women during ante-natal and post-natal visits on the benefits of breastfeeding and have been calling on the community to support working mothers achieve optimal breastfeeding.

With a package of actions, policies, and programs to support mothers at health facilities, at home, and at work, breastfeeding rates can dramatically increase in Tanzania and have greatly improve children’s health and development.

This special project was produced with support from the International Centre for Journalists (ICFJ)

The author is an Early Childhood Development Fellow with the International Centre of Journalists

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No selfies in the hospital, please

Monday December 24 2018

 

By Dr Nelly Bosire

Being a patient puts you in a vulnerable position – you have to put your trust in strangers to care for you in a manner that even a family member may not be able to.

And not only that, to trust that the stranger with whom you will likely share your innermost secrets, will keep them confidential and not breach the trust you have placed in them and your privacy.

Very few people would allow their spouses to give them a bedpan, yet in the hospital, they will trustingly take their clothes off for a stranger to touch and probe them at will.

This demonstrates the power healthcare providers wield over their patients.

To safeguard the patient in this seemingly imbalanced equation. We have the Hippocratic Oath and the Nightingale Pledge that have endured the test of time to protect patients. The oldest and most binding of all pledges for physicians is the Hippocratic Oath: What I may see or hear in the course of treatment or even outside of treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

Modification of the oath

Subsequent modification of the oath to keep with the times has not changed anything with regard to patient privacy.

It maintains: I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.

For nurses, the Nightingale Pledge states: I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my calling.

One of the most solemn ceremonies in the medical profession is the oathing ceremony. Passing the final examination in medical school is not a passport to practise medicine in Kenya. The somberness with which this ceremony is carried out reflects the great responsibility that practitioners bear when they go forth in the world and touch patients.

New doctors are inducted into the profession with an overview of the responsibility they are about to sign on to, the Code of Professional Conduct that they shall ascribe to and the disciplinary measures in place that deal with deviance.

Not unique

During university graduation ceremonies, it is only doctors who must publicly recite the oath as they accept their degrees.

This practice is not unique to Kenya. It happens all over the world with procedural variations but with a common goal.

It is therefore infuriating to see practitioners who have utter disregard for the oath in the age of social media. Social media has greatly enhanced information sharing, learning, consulting and updates in the world of medicine. This has greatly benefitted patients with improved care and better outcomes at a click of a button.

However, social media in healthcare settings comes with pitfalls, with a new crime slowly rearing its ugly head, when the professionals entrusted to safeguard the most vulnerable, breach their privacy at the click of a button.

We must all rise and take issue with healthcare providers who are willfully embarrassing the noble profession by callously exposing their patients. Malawi set the pace by suspending a nurse who took a selfie in the labour ward with an exposed mother behind her on the delivery couch.

It is imperative that proper investigation and appropriate disciplinary measures be taken to safeguard patients.

Just when I thought it could not get any worse, a friend sent me a tweet from a Nigerian doctor in Enugu, who made fun of his patient in labour for passing stool during childbirth.

I am still flaming with anger. As an obstetrician/gynaecologist who spends her days helping mothers walk through the miracle of bringing forth life, I was extremely miffed, as I believe my colleagues would be too.

Barely a day later

Barely a day later, another allegation of a social media post made by health professionals, all smiles in an operating room with the patient right behind them found its way to my phone, and I had to pose and ask the hard questions.

Where are we going wrong? Do our medical, nursing and clinical medicine students appreciate the bioethics and jurisprudence courses they take? Are we doing enough on mentorship with regard to professional conduct?

The developed world already has clear guidelines and policies regulating social media interaction for health practitioners.

For instance, the General Medical Council in the United Kingdom has a whole section on social media under its “Ethical Guidance” rules.

Up to par

The Medical Board of Australia is equally up to par with its guidelines on the use of social media by health practitioners, in relation to their patients. The American Medical Association clearly spells it out under the Code of Medical Ethics Opinion 2.3.2.

The message must be clear to all and sundry: forget millennialism, patient privacy is sacrosanct and must always be regarded as so!

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Indeed, One Health is the way to go

Monday December 24 2018

A chart explaining how AMR spreads. PHOTO |

A chart explaining how AMR spreads. PHOTO | WORLD HEALTH ORGANISATION 

By Nelly Bosire

An article in Your Health magazine last month, titled: One Health: Why Tanzanian scientists must unite, prompted me to go deeper and make an analysis on this topic—Antimicrobial Resistance (AMR).

For starters, AMR means when microscopic organisms such as bacteria, viruses and fungi change in ways that render ineffective the medication used in curing the infections they cause.

It was so encouraging to learn that experts such as Prof Robinson Mdegela from Sokoine University of Agriculture (SUA), are on top of the fight against AMR.

He spoke, in Your Health, about the need for scientists to unite, but before that, I had paid attention to his remarks as he elaborated during the Cuhas- Bugando Scientific Conference.

Prof Mdegela said, “Antimicrobial Resistance (AMR) does not recognise geographical borders or human-animal borders, it’s a global threat which keeps on expanding daily, there is no way that this problem can be solved in an isolation manner but rather by coordination, this is why we need to attach to One health Approach.”

Basically, there is a growing need for professionals from different fields to come together in order to seek sustainable solutions for various global challenges. One Health Approach policy was officially launched in Tanzania in 2018.

Let’s clear the misconception

I have also noted the confusion which exists among many professionals concerning the One Health Approach, especially what some of the professionals think when talking about it.

It does not mean that a person needs to spend most his/her life time studying to accumulate various skills, studying to be a Doctor of Medicine, then go for Bachelor of Pharmacy, there after he/she goes again for Nursing studies and so on, this is totally opposite from the true meaning of One Health Approach.

One Health Approach ought to mainly improve the interdisciplinary strategy. This means that there should be a strong interaction among different sectors regardless of their titles when fighting against AMR.

One Health Approach call upon all sectors, law, finance, health and all other institutions to seek the proper solutions.

Why antimicrobial resistance exists?

Drivers for AMR are mainly behavioural practices from both health professionals and their clients/patients. Over- prescription, wrong prescription, use of incomplete dose, sharing of antibiotics and progressively use of antibiotics in animals are some of the acts which in fact propel the expansion of AMR among us as sited out through various researches.

What can be done

Rectification of these behaviors needs a proper collaboration, communication and an outstanding coordination among health professionals and all other professionals together with their clients throughout the globe, these three pillars are to be implemented from the family level to the whole community.

Global Action plan suggests methods through which we can combat the AMR challenge under One Health Approach, as these methods are being adopted by other countries then Tanzania as well should join the race as strongly pointed out by Prof. Mdegela;

• Improve awareness and understanding across sectors.

• Strengthen knowledge and evidence base surveillance and researches across sectors.

• Reduce incidence of infection.

• Optimise or rationalise the use of Antibiotics.

• Sustainable investment.

Agricultural sector more specifically livestock keeping was mentioned to be among the crucial points in battle against AMR since it’s among the places where Antibiotics use is highly encouraged.

One Health Approach aims at eliminating these invisible barriers so as to make sure there is no any angle through which AMR can spread furthermore.

The author is based at Catholic University of Health and Allied Sciences.

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More than 90% of the world’s children breathe toxic air every day

Monday December 24 2018

 

Every day around 93 per cent of the world’s children under the age of 15 years (1.8 billion children) breathe air that is so polluted it puts their health and development at serious risk. Tragically, many of them die:

World Health Organisation (WHO) estimates that in 2016, 600,000 children died from acute lower respiratory infections caused by polluted air.

A new WHO report on Air pollution and child health: Prescribing clean air examines the heavy toll of both ambient (outside) and household air pollution on the health of the world’s children, particularly in low- and middle-income countries. The report is being launched on the eve of WHO’s first ever Global Conference on Air Pollution and Health.

It reveals that when pregnant women are exposed to polluted air, they are more likely to give birth prematurely, and have small, low birth-weight children.

Air pollution also impacts neurodevelopment and cognitive ability and can trigger asthma, and childhood cancer.

Children who have been exposed to high levels of air pollution may be at greater risk for chronic diseases such as cardiovascular disease later in life.

“Polluted air is poisoning millions of children and ruining their lives,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“This is inexcusable. Every child should be able to breathe clean air so they can grow and fulfil their full potential.”

One reason why children are particularly vulnerable to the effects of air pollution is that they breathe more rapidly than adults and so absorb more pollutants.

They also live closer to the ground, where some pollutants reach peak concentrations – at a time when their brains and bodies are still developing.

Newborns and young children are also more susceptible to household air pollution in homes that regularly use polluting fuels and technologies for cooking, heating and lighting

“Air Pollution is stunting our children’s brains, affecting their health in more ways than we suspected. But there are many straight-forward ways to reduce emissions of dangerous pollutants,” says Dr Maria Neira, Director, Department of Public Health, Environmental and Social Determinants of Health at WHO.

“WHO is supporting implementation of health-wise policy measures like accelerating the switch to clean cooking and heating fuels and technologies, promoting the use of cleaner transport, energy-efficient housing and urban planning.

We are preparing the ground for low emission power generation, cleaner, safer industrial technologies and better municipal waste management, ” she added. (WHO)

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